Lesser Toe Surgery

You have been advised to have surgery on the forefoot which may consist of bone cuts (osteotomies) to the lesser metatarsals and/or surgery to the toes. The aim of surgery is to reduce the pain and improve your foot function. In addition, any toe deformities will be corrected.

  • The aim of surgery is to reduce pain and improve your foot function correcting any toe deformities at the same time.
  • There are several small surgical procedures which can be utilised depending on the exact nature of your problem.  Combinations of these are often used to achieve the best result.  In principle these are tendon lengthening or division, soft tissue release of joints and bony surgery.
  • If the metatarsal bones are cut (Weil’s osteotomies), you will have one or more incisions placed on the top of your foot, in line with the bones.  If two adjacent bones need surgery, then one incision will be used, placed between the bones.
  • The bones will be cut using a saw and stabilised using metal screws. These will remain in your foot permanently and rarely cause problems.
  • If the toes are operated on then you will probably have a small metal wire inserted which will stick out of the end of the toe.
  • You will be in hospital for one night and will mobilise with the help of the physiotherapists using a heel-bearing shoe.  Your toes and foot will swell following surgery and this finally resolves approximately three months post-operatively.
  • You will be seen in clinic at one week after surgery to check the wounds and the stitch ends will be trimmed. Thereafter, you will continue to mobilise in the heel-bearing shoe, which relieves pressure from under the front of the foot. You will be shown exercises to perform on any toe joints which are not transfixed with wire as stiffness can occur as a result of the operation.
  • An X-ray will be required at six weeks to check on metatarsal bone healing but if surgery only involved the toes no X-ray will be needed.
  • Once an X-ray shows the bones to be healed you will be allowed to walk in more normal footwear and gradually introduce exercise.  You will be walking completely comfortably by approximately three months, though the end point of recovery may be many months.
  • Occasionally complications occur as in any operation. There is a risk of infection, which is less than 1%.  If infection occurs antibiotics will be prescribed.  Very rarely infection will involve the bones which may require more aggressive treatment such as washing the wounds under a further anaesthetic. Occasionally there may be nerve injury during the operation such that you have numbness or pins and needles along the toe. This is usually temporary although on occasion may persist permanently. This usually does not cause problems however.
  • The toe joints may be stiff after surgery requiring more physiotherapy and home stretching. Occasionally joints require manipulation under another anaesthetic.  Other rarer complications include thrombosis in the leg.  Most people recover well from forefoot surgery.

Post-operative Program