Phalangeal head resection (arthroplasty) for toe joint deformities

Surgery Overview

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Surgeons often use phalangeal head resection to correct hammer, claw, and mallet toes. In this procedure, the surgeon removes part of one of the toe bones, the phalangeal head, so that the toe can lie flat. The affected tendons are cut and then reattached to conform to the new, correct toe position. A wire or tape holds the straightened toe in place until it has healed.

A variation of this surgery, implant arthroplasty, uses an implant made of an man-made material such as silicone to replace the removed bone segment.

You will probably have this surgery as an outpatient. You will not have to spend a night away from home.

View a slideshow of phalangeal head resection for a fixed hammer toe.

What To Expect After Surgery

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The wire or tape used to hold the toe in the correct position usually remains in place for 3 to 6 weeks. Your toes may be taped together for 4 more weeks while they adjust to their new positions. You may be able to walk on the affected foot right after surgery, possibly with a special shoe. How soon you can start wearing your own shoes depends on how quickly you recover. You may need a follow-up X-ray.

Why It Is Done

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If you have severe pain in a toe that interferes with your daily activities, and nonsurgical treatments such as roomier footwear, exercises, and pain relief medicine have not helped, you and your doctor may choose to try a phalangeal head resection.

How Well It Works

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The success of surgery for hammer, claw, and mallet toes has not been widely studied. The specific results and risks vary depending on the type of surgery, your surgeon's experience, and how severe your deformity is. After surgery, most people have toes that lie flat but do not have normal flexibility.¹

Risks

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Possible complications of surgery include:

• Infection, bleeding, and pain, which can occur after any surgery.
• Long-term (chronic) swelling of the affected toe.
• Numbness in the affected toe.
• Limited range of motion in the affected toe.
• Risks of anesthesia, such as a change in your blood pressure. Your specific risks depend on the type of anesthesia used, your health, and your response to the medicines used.
• Problems with blood flow in the toes, which may result in losing some or all of the toe. How likely this is depends on how deformed and rigid your toe is.

What To Think About

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Hammer, claw, and mallet toes may come back after surgery. Loose ligaments in the foot or a foot that rolls inward too much (excessive pronation ) when you walk may cause the toe problem to return.

The affected toe or toes may remain somewhat bent after surgery.

Although surgery can reduce pain, it may not improve how your foot looks.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Frey C, ed. (2005). Toe deformities section of Foot and ankle. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 703–707. Rosemont, IL: American Academy of Orthopaedic Surgeons.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Gavin W.G. Chalmers, DPM - Podiatry and Podiatric Surgery
Last Updated	July 11, 2007