Often patients will present with a painful toe or painful lesion under the toe. A hammer toe procedure is usually performed on one the lesser digits. Conservative care options include wearing non-constrictive footwear, using appropriate footwear with orthotics or orthopedic inserts and on occasion, appropriate padding may be rendered. Should you, the patient, become frustrated with these conservative efforts, surgical intervention may be contemplated. If surgery is indicated, a simple procedure often will provide lasting relief. During your preoperative visit, there is a discussion of risks and benefits including relief of pain. The risks are soft tissue or bone infection, recurrence of this problem, as well as painful scars or perhaps permanent numbness. The risks and benefits will be reviewed and all questions are encouraged and should be answered prior to an operative procedure. Specific preoperative instructions are provided to the patient. Preoperative instructions such as having nothing to eat or drink after midnight on the day of the procedure. As well as directives for keeping the area clean and dry and appropriate use of post-operative medications are covered.
As you arrive in the Operative Suite, the patient is usually moved from a gurney to an operative table. Once appropriate anesthesia or sedation is provided, the involved digit is cleansed with alcohol or Betadine or appropriate antiseptic. Local anesthetic is infiltrated around the base of the toe and perhaps even into the metatarsal area as needed. The foot is appropriately prepped and draped. After the surgeon has scrubbed his hands, the surgeon is then gowned and gloved. A tourniquet may, or may not be used, at the level of the ankle, calf or thigh or a digital tourniquet may be utilized. If the apex of the deformity is over the proximal interphalangeal joint of the digit, a two centimeter dorsal linear incision is performed over the proximal interphalangeal joint. The incision is deepened through the epidermal layers of the skin. Blunt and sharp dissection is carried through the fine layers down to the level of the proximal interphalangeal joint and the lower level of the long extensor tendon which extends over the proximal interphalangeal joint. The area is irrigated, electro-cautery is utilized as necessary. The long extensor tendon is released at the level of the proximal interphalangeal joint. A sterile staple is again used to release all soft tissue structures around the head of the proximal phalanx. A small saw using either a saggital or oscillating blade is utilized to dissect the head of the proximal phalanx. Again, the area is irrigated and any sharpened edges are smoothed with a rongeur or hand or power instrumentation. The long extensor tendon is re-approximated with 3-0 Vicryl and 4-0 Prolene is used to re-approximate the skin edge. A sterile non-stick dressing is applied over the surgical incision site. A Betadine soaked 2X2 is wrapped around the digit. A supportive dressing is provided to the foot. An Ace bandage wrap may also be applied to the foot, ankle and lower leg as needed.
After the appropriate post-anesthestia period has passed, the patient is discharged to home with specific directives for appropriate use of post-operative pain medication. The need for elevation of the foot and keeping the dressing clean and dry, the patient is also advised to follow-up as directed. The patient is also advised to call if there should be any questions or problems that many arise at any time. More often than not, an uneventful post-operative course involves dressing changes through the first week to ten days as well as suture removal at one to two weeks at he discretion of the surgeon. It is important to have close follow up with your surgeon as complications may occur. Should a complication of a postoperative infection or other problems occur these are issues that can be brought to the attention of the surgeon during the post operative course following your surgical procedure. It is important for you to contact your surgeon should you have any questions or problems at anytime following your procedure.
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| Gary W. Chessman DPM, FACFAS - Podiatric Surgeon |
Podiatry Orlando - Chessman, Gary W., DPM, FACFAS - Podiatric Surgeon
7560 Red Bug Lake Rd Suite 2024 #2024, Oviedo, FL 32765-6591
(407) 679-7444
podiatryorlando.com
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