Services
All About Toe Surgery
Deformities of the toes are among the most common problems I see in clinic. They range from mildly inconvenient to significantly painful and disabling, and whilst many can be managed with appropriate footwear, padding, or orthotic insoles, there comes a point for many patients where conservative measures are no longer sufficient and surgery offers the most effective and lasting solution.
Toe deformity surgery is generally well tolerated, and performed under local or general anaesthetic as a day case. The aim is to correct the structural problem, relieve pain, and restore the ability to wear normal footwear comfortably.
Common Toe Deformities
Hammer Toe
A hammer toe deformity involves a flexion contracture at the proximal interphalangeal (PIP) joint — the middle joint of the toe — causing the toe to buckle downward and adopt a hammer-like shape. The prominent joint rubs against footwear, causing painful corns on the top of the toe, whilst the tip of the toe may press against the sole of the shoe. The second toe is most commonly affected, though any lesser toe can be involved.
In its early stages, a hammer toe may be flexible — meaning it can be straightened manually — and at this point simpler interventions such as splinting or flexor tenotomy may be effective. Once the deformity becomes rigid and fixed, surgical correction of the joint itself is required.
Claw Toe
A claw toe involves hyperextension at the metatarsophalangeal (MTP) joint — where the toe meets the foot — combined with flexion at both the PIP and distal interphalangeal (DIP) joints. This gives the toe a clawed appearance, with the tip driven downward and the base of the toe lifted. Painful corns can develop both on the top of the toe and underneath the tip, and prominent metatarsal heads beneath the ball of the foot often cause additional forefoot pain.
Claw toes are frequently associated with underlying neuromuscular conditions, inflammatory arthritis, or longstanding flatfoot or high-arch deformity, and a thorough assessment is important to identify and address any contributing factors.
Mallet Toe
A mallet toe involves a flexion deformity specifically at the distal interphalangeal (DIP) joint — the joint closest to the tip of the toe — causing the tip to curl downward and press against the ground or the toe box of the shoe. It most commonly affects the second toe and can cause a painful corn or callus at the very tip of the toe.
Crossover Toe & Toe Instability
A crossover toe occurs when one toe — most commonly the second — drifts sideways and rides over or under its neighbour, usually the big toe. This results from instability or rupture of the plantar plate, the strong ligamentous structure that stabilises the toe at its base, as well as weakness of the surrounding soft tissue structures. It can cause significant pain in the ball of the foot as well as difficulty with footwear, and often progressively worsens without treatment.
Early identification of plantar plate dysfunction is important, as repair is more straightforward and outcomes are better when the problem is addressed before complete structural failure has occurred.
Overriding & Underriding Fifth Toe
Deformities of the little toe — including overriding (where the toe sits on top of the fourth toe) and underriding positions — can cause persistent pain, difficulty with footwear, and skin breakdown from abnormal pressure. These deformities may be congenital or acquired and, whilst often dismissed as minor, can be a significant source of discomfort and frustration for patients who struggle to find comfortable shoes.
Surgical Treatment Options
The surgical approach is tailored to the type, severity, and flexibility of the deformity, as well as whether one or multiple toes are involved. Procedures are performed under local anaesthetic as a day case, and in many cases several deformities can be corrected at the same time.
Flexor Tenotomy
Division of the flexor tendon to release a flexible deformity. A simple, minimally invasive procedure well suited to flexible hammer or mallet toes, often requiring only a small stab incision. Quick recovery and good results in appropriate cases.
Proximal Interphalangeal Joint (PIPJ) Arthroplasty
Removal of a small section of bone from the PIP joint to allow the toe to straighten and remove the prominent joint. The joint is sometimes held in position with a temporary K-wire whilst the soft tissues heal in the corrected position. Often used in patients when a fusion is not suitable.
Interphalangeal Joint Fusion (Arthrodesis)
Permanent fusion of the PIP or DIP joint in a straightened position, indicated for severe or recurrent deformity. Provides a more durable correction than arthroplasty. Fixed with an intramedullary screw or K-wire. Preferred for patients requiring a long-lasting result or where previous surgery has failed.
Tendon Transfer
Re-routing of a flexor tendon to the top of the toe (flexor-to-extensor transfer) to correct a claw or hammer deformity by actively pulling the toe into a straighter position. Particularly useful in flexible deformities where the toe can be corrected passively but lacks the muscular balance to maintain the corrected position independently.
Metatarsophalangeal Joint (MTPJ) Release
Release of the tight structures around the MTP joint to correct hyperextension and allow the toe to sit in a normal position. Commonly combined with toe joint surgery for claw or crossover toe correction. Often performed alongside metatarsal osteotomy where metatarsal head prominence is a contributing factor.
Plantar Plate Repair
Surgical repair of the torn or attenuated plantar plate ligament to restore stability to the MTP joint and correct crossover or deviated toe deformity. Often combined with an extensor tendon lengthening and MTPJ release. A more complex procedure with a longer recovery, but offers the best chance of a stable, well-aligned toe in the long term.
Syndactylisation
Surgical joining of two adjacent toes with a small skin flap to hold a deformed or unstable toe in a corrected position. Most commonly used for overriding or underriding fifth toe deformity and for recurrent crossover toes where other procedures have been unsuccessful. A simple and effective technique with a reliable outcome.
Metatarsal Osteotomy
Surgical cutting and repositioning of the metatarsal bone to elevate or shorten a prominent metatarsal head that is driving toe deformity or causing metatarsalgia. Commonly performed alongside toe joint surgery to achieve a balanced forefoot and prevent early recurrence of the deformity.
What to Expect After Toe Surgery
Day Case Procedure
All toe surgery is performed under local or general anaesthetic and you will usually go home the same day. Overnight hospital admission is usually only required in exceptional circumstances.
Post-Operative Shoe
Most patients can walk immediately after surgery in a post-operative sandal or wide shoe. Crutches are only sometimes required for isolated toe procedures.
Return to Shoes
Most patients return to a wide, comfortable shoe at six weeks, and to normal footwear by eight to twelve weeks depending on swelling.
Swelling
Some swelling in the operated toe is normal and can persist for several months. This is not a cause for concern and settles progressively with time.
K-Wire Removal
Where a K-wire has been used for fixation, it is removed in clinic at around six weeks. This is a quick and straightforward outpatient procedure.
Return to Activity
Low-impact activity can usually resume from six to eight weeks. Return to sport and vigorous activity is typically possible from three to four months.
Risks & complications: As with all surgery, toe procedures carry a small risk of infection, wound healing problems, nerve sensitivity, and recurrence of the deformity. Stiffness in the operated toe is common and may be permanent, particularly following joint fusion. There is also a risk that the toe may not heal in the exact position intended, or that a previously flexible deformity may become stiffer after surgery. Sometimes the toe will sit slightly elevated or ‘float’ after surgery. All risks will be discussed in full at your consultation before any decision to proceed is made.
Many patients with toe deformities have been told at some point that surgery is not worth it for such a small problem, or that they should simply live with it. In my experience, well-planned and appropriately timed toe surgery can make a significant difference to comfort, footwear choice, and quality of life — and for many patients, the recovery is considerably more straightforward than they anticipated.