Percutaneous toe claw surgery

Percutaneous claw toe surgery: management and post-operative follow-up?

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Presentation of the pathology

The toes are composed of 3 bones called phalanges. Each phalange also consists of 3 parts: the head, the body and the base. The joints between the phalanges are called interphalangeal joints. The claw toe is a deformation that affects one or both of the interphalangeal joints. It is characterized by an abnormal curl or bending of the lateral toes. This deformation can affect all the toes, more rarely the big toe. The most common deformation is the claw of the 2nd toe.

The claw toe can be corrected by a percutaneous operation.

Causes and Aggravating Factors

Toe claw deformation can be caused by many factors:

  • Wearing shoes that are too tight or short

Worn over a long period of time, this type of shoes will squeeze the toes. Indeed, the toes are pushed towards the front of the shoe and compressed in a small space.

  • The presence of pathologies or conditions

Pathologies or conditions such as obesity, menopause, ligament hyperlaxity or spinal cord injury can lead to the appearance of toe claws.

  • Presence of other foot deformations

The claw toe can also be a complication of a hallux valgus or hollow foot.

  • Family history or sequelae pathology

This deformity can also be a sequel to an inflammatory or neurological condition (stroke…).

Symptoms and Complications

The symptoms of the clawed toe are easily identifiable:

  • Patient complains of discomfort and pain in shoes when walking
  • Toe bends down and looks like a claw
  • Horns and calluses appear on the friction areas of the deformed toe
  • Patient has difficulty bending foot or moving toes

In case of late management of the pathology, complications may appear. The toe will eventually stiffen and horns or calluses will form, causing significant pain for the patient.

Diagnosis by a claw toe surgeon

The diagnosis of the claw toe is based on the clinical examination of the foot. If in doubt, the toe claw surgeon may ask you to perform medical imaging exams to confirm the diagnosis. The purpose of these examinations is to highlight deformed joints. The radiographs are performed from the front and from the profile to visualize the magnitude of the deformation.

Medical treatment by a claw toe specialist

Depending on the patient’s case and the extent of the deformity, the claw toe specialist can decide which is the best treatment to implement.

Where possible, medical treatment is preferred.

Several treatments can be considered:

  • Physiotherapy

Rehabilitation of the joints helps to maintain some joint flexibility and reduce tension and stiffness of the toe.

  • Adaptation of the footwear

Wearing suitable, wide and more flexible shoes will greatly reduce the pain.

  • Wearing equipment such as orthopedic soles and toe orthotics

These devices do not allow to treat the deformation but to limit its evolution. In particular, they help to harmonize plantar support and limit consequences of claws scratching on the skin.

Minimally invasive toe claw surgery

In the absence of improvement after 3 months of conservative treatment, a surgical treatment should be discussed. Your surgeon will discuss surgical options and select the most appropriate surgical approach. If possible in your situation, Dr. Julien Lopez will perform minimally invasive toe claw surgery.

The objective of the intervention is to realign the toe. In most cases, the percutaneous technique is preferred. The surgeon then makes mini-incisions and operates under radiographic control.

Several surgical actions can be performed during percutaneous toe claw correction:

  • Osteotomy
  • Tendon lengthening or section (tenotomy)
  • Shortening of the phalanges
  • Planing of bone growth

During the operation, Dr. Julien Lopez makes mini-incisions of 1 to 2 mm without opening the joint. Small instruments are then inserted through these incisions to perform surgical procedures.

Laser claw toe surgery is often confused with percutaneous surgery. The surgeon makes one or more small incisions on the toe to realign the toe. The surgeon can also treat deformities associated with the claw toe during the operation.

In the most serious cases, the surgeon can perform percutaneous arthrodesis of the toes in claw, that is to say a surgical fusion of the joint. This gesture is used when the joint is stiff. This technique requires the installation of temporary hardware or pins that will be removed later.

The procedure usually takes place under local anaesthesia.

In the presence of a quintus varus, percutaneous elevation surgery of the 5th metatarsal is performed on an outpatient basis. It lasts on average 30 minutes. The patient will be able to return home only a few hours after surgery.

Once the operation is complete, Dr. Julien Lopez will give you all the instructions and information necessary to ensure that your recovery is carried out in the best conditions.

Minimally Invasive Toe Surgery: Surgical Suites

The post-operative phase of the minimally invasive toe claw surgery is an essential step in the patient’s recovery.

As soon as you leave the operating room, walking is allowed with the help of the shoe prescribed by your surgeon on discharge. It is to be worn for 3 weeks.

The first repair of the dressing takes place 21 days after the intervention or every 2 days depending on the gesture made. A post-operative follow-up is provided by Dr Julien Lopez. Until the 2nd consultation at 2 months post-operative.

Driving is not recommended for 3 weeks after the procedure.

Physiotherapy is not systematic. Your surgeon can tell you if it is useful in your case.

The intervention of the clawed toes requires sick leave of between 15 days and 6 weeks on average.

The patient can resume their sports activities 2 months after the surgery in the absence of pain.

Dr Julien Lopez does not claim to be the best toe surgeon in the world. On the other hand, he respects the surgical indications taking into account the patient’s expectations and ensures rigorous follow-up after an operation.

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The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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