What Is Long Toe and Toe Shorting? A long toe is exactly what the name describes, a long toe. The long toe can be straight or buckled. Over time, a straight long toe can become buckled forming a hammer toe. Any of the toes may be considered long, but the 2nd toe is most commonly long.
Symptoms Of A Long Toe
Patients with a long toe may pain associated with the tip of the toe. Excessive pressure from shoes may result in the formation of a hardened portion of skin (corn or callus) on the tip of the toe. A buckled long toe (hammer toe) can also have pain and callus formation over the toe knuckles. Some people may not recognize that they have a long toe, rather they identity the excess skin build-up of a corn.
The toe(s) may become irritated, red, warm, and/or swollen. The pain may be dull and mild or severe and sharp. Pain is often made worse by shoes, especially shoes that crowd the toes. While some long toes may cause significant pain, others may not be painful at all. Painful toes can prevent you from wearing stylish shoes. A long toe is at risk to progress onto a hammer toe as the tip of the shoe pushed directly on the toe – causing it to contract. Over time, the toe can become permanently contracted.
Causes Of A Long Toe
Genetics (hereditary) is most common reason for a long toe. The toe itself may be excessively “long” or the toes adjacent may be short in comparison – making a toe appear long. A short big toe will make the second toe longer. A bunion (medically called, hallux valgus) will effectively shorten the great toe, making the second toe prominent and long. The presence of a bunion with a long 2nd toe can lead to a hammer toe or a crossover toe.
When to Seek Hammer toe Treatment
Common reasons patients may seek treatment for a long toe are:
- Toe pain on the tip
- Thick toe calluses
- Interference with walking/activities
- Difficulty fitting shoes
- Worsening toe deformity
- Unsightly appearance
Depending on your overall health, symptoms and severity of the hammer toe, the condition may be treated conservatively and/or with surgery.
Non-operative Treatments For A Long Toe
Non-surgical methods for a long toe are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger problem.
Simple treatments patients can do are the following:
- Wear supportive shoes
- Use an arch support
- Wear shoes with a wide toe box
- Modify activities
- Spot stretch shoes
- Periodic callus care
Non-surgical treatments Dr. Gephart may add:
- Anti-inflammatory Medicines: Prescription strength medicines to decrease pain and inflammation.
- Physical Therapy: To strengthen poorly functioning muscles and stretch tight muscles that may be exacerbating the toes. Special ultrasound techniques may reduce inflammation.
- Custom Foot Orthotics: Dr. Gephart creates an orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort and prevent future progression.
- Toe Splints or Pads: Specific pads may prevent pressure and physical irritation in shoes. Bunion splints and toe spacers physically realign the toes and can lessen pain and halt or stall hammer toe progression.
- Injections: Cortisone injections are strong anti-inflammatory agents to decrease pain, and swelling directly at the toe region. Injections only treat the symptoms, and in some cases used in caution (and sparingly) they can weaken supporting ligaments of the toe(s).
Toe Shortening Surgery
Long toes can be surgically shortened. Depending on the severity and length of the toe, there are several methods to surgically correct shorten a toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.
How Are Long Toes Surgically Corrected?
The basis for toe shortening surgery most often involves removing s portion of bone within the toe. Often pinning the toe with a surgical wire is performed.
There are generally two methods surgeons use to correct shorten toes – they are joint resection (arthroplasty) or bone mending (fusion), and the location where this is performed on the toe depends on where the toe is deemed “long” or at the location of bucking (if present). Its important to recognize that most of the surgical work involved the joints of the toe, not the joint of the ball of the foot.
- Joint resection procedures involves removing a small portion of one of the two small joints of the within the toe itself. Medical terminology for this procedure is called an interphalangeal joint arthroplasty.
- Bone-mending procedures shorten the contracted toe by removing an entire small joint of the toe. This allows for the bone ends to mend together in a shorter position. Often surgical hardware (fixation) is necessary to keep the bones steady during healing. Hardware options can involve a buried implant inside the toe, or a temporary wire that is removed at a later date. Medical terminology for this procedure is called an interphalangeal joint arthrodesis (fusion).
Toe Shortening Surgery Recovery
Recovery after toe shortening surgery, is the same as recovery from hammer toe surgery. Recovery depends on the method of surgery performed. In all cases, healing takes about 6 weeks in healthy people and there is no way to speed up that process. Patients often return to normal activities and shoe gear by 2 weeks to 3 months depending on just how severe the toe deformity was preoperatively. Simple toe surgery can recover very quickly, and return to a shoe in two weeks. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.
Walking After Toe Shortening Surgery
Nearly all of Dr. Gephart patients are walking immediately after toe shortening surgery in a stiff soled surgical shoe. In general, walking is dependent on the method (procedure) surgeons choose to correct the toe and the techniques used to stabilize the digit while mending. Also, the ability to mobilize quicker depends on which toe was operated on. In general, the Fourth and Fifth toe allows for a quicker return to shoes, as these toes are not needed for propulsion. The Second toe, however, is the most commonly longer and because this is need for push off gait, may prolong return to shoes slightly.
What Anesthesia Is Needed For Toe Shortening Surgery
Toe Shortening surgery is performed as outpatient surgery (this means you go home the same day). It may be performed in a hospital, ambulatory surgery center and even in the doctors office (so long as the facility is set up for surgery).
The surgery can be performed under a local, regional, spinal or general anesthetic. Local and regional blocks, with monitored anesthesia care are most commonly performed. This means that the foot will be numbed with an anesthetic while an anesthesiologist provides sedation to relax you.
Is Hardware Implanted Into The Foot With Toe Shortening Surgery?
The use of surgical hardware for toe shortening surgery is very common, and depends on the severity of the problem and which toe is operated on. The 5th toe rarely requires surgical hardware, while the 2nd toe almost always does. Surgical hardware may involve stainless steel wires, screws, synthetic material, absorbable pins, cadaveric bone, and/or specialty fixation devices.
Will Hammer Toe Surgery Also Remove The Corns On The Toe?
Long toes that are not buckled tend to have corns at the tip of the toe. In general, correcting the toe problem will also resolve the corn buildup.
What Are The Risks Of Toe Surgery
There are general risks associated with toe shortening surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.
Toe surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, disability, recurrence, flail toe, new toe deformity, metatarsalgia, unsightly scar, stiffness, shortness of toe, weakness in toe, loss of toe to purchase ground, hardware problems, need for revisional surgery, and/or catastrophic loss.
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