It may look and sound crazy but pins sticking out of toes
are normal! You can imagine the
disbelief on a person’s face when I tell them they may wake up from surgery
with pins sticking out of their feet.
“Don’t worry, I’ll remove them in my office and you won’t feel a
thing.” It sounds crazy but I’m being
serious! Kirschner wire or k-wire is a
small pin commonly used in foot and ankle surgery and is routinely used in toesurgery.
A hammertoe is a dreadful toe deformity that can cause pain,
discomfort, difficulty fitting in shoe gear and appear unsightly. Few people can ignore the annoyance of
hammertoes because they often progressively get worse over time. I’ve seen patients have to completely dismember
their shoes, cutting holes to allow their toes to fit in the shoe box. The cause can be complex and is largely
attributed to a tendon imbalance caused by an abnormal foot type. The result is
bones buckling up on one another causing the knuckle of the toe to stick up in
the air. Most people complain of the knucklerubbing on the shoe and forming corns. Another
common complaint is pain at the tip of the toe that is now bearing more
weight. Pain around the nail can also occurrence
because the nail will often rub against neighboring toes.
Unfortunately, little can be done to treat hammertoes
conservatively. A wider shoe with alarge toe box is the best advice. Tapingor padding around the toes can help to relieve symptoms periodically but does
not treat nor reverse the deformity.
Hammertoe is a common surgical procedure with some variability. Depending on the flexibility of the toe,
sometimes it is only necessary to remove a small part of bone to straighten the
toe. Often, it is necessary to fuse the
bones to ensure the toe remains strait.
Toe surgery is performed in a step wise fashion and until the toe is
strait. First the bone is cut to allow
more space in the joint. This is then
followed by surrounding soft tissue procedures to completely straiten the toe. There are several different implants that can
be placed in the bone at the joint to fuse the two bones. These have become more popular over the years
and k-wires are being used less, but still k-wires remain the gold standard of
treatment. The k-wire is drilled through
the toe to keep it strait during the healing process to ensure a better recover
and appearance of the toe after surgery.
The pin is pulled several weeks after surgery and is completely
painless.
It probably still sounds a little funny and maybe a bit
scary, but nothing abnormal about waking up from toe surgery with some
external hardware. As I described
before, toe surgery is done in a step wise fashion until the toe is
strait. Not all toes surgery needs a
k-wire or joint implant. This depends on
the severity of the deformity .
