Will I Need Pins in my Toes after Surgery?

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 . 

Corns 101

Corns have been the bane of your toes since the invention of closed toe shoes. People resort to all sorts of home remedies to try and relieve themselves of the little devils. The cure is really very simple…prevention.

Corns are those thick, often painful excrescences that pop up on the top joints of your toes after wearing shoes that are either too short or too narrow (or both). Toes like to lie flat inside of shoes for a comfortable walking experience. Style often dictates otherwise in the form of shoes that are too narrow, or in the case of ladies shoes, having a high heel that pushes the toes together and rubbing them at the top of the shoe. Over time, this cramping of the toes causes the tendons on the tops of the toes to shorten causing a contracture of the toe till it assumes the shape of a “hammer”. Thus the “hammertoe” is born. That round, thickened skin on the top of the toe joint is in fact the “corn”. Shaving off the corn or padding it only gives temporary relief. The cure comes in two forms.

First part of the cure would be prevention. The shape of the shoe must fit the shape of the foot. Corns and the contracted digits don’t occur with the wearing of just one pair of shoes for an evening. They occur over several years of shoe abuse to your toes. Many people feel they know the size of their feet and, and buy shoes without even trying them on. Fashion often dictates the shape of the shoes and height of the heels. Over years, this is the recipe for painful corns and hammertoes.

Second part of the cure if you fail to heed the advice of the above paragraph, would be correction. This involves the surgical correction of the digits with the removal of a small piece of bone that has come to form the corn as well as the lengthening of the tendon that caused the toe to hammer. The human body is an amazing thing. If the toes are continuously stuffed into shoes that are too small, the tendons contract and eventually stay that way. “Hammertoe” correction to relieve the pain of the corns is a simple outpatient procedure, but why not try and avoid the problem in the first place?

Ladies…I’m not saying that you can never wear fashionable, high heels shoes. All I am saying is that you should use sensibility in when and where you wear them.
Men also suffer from this painful malady. Though they may not be in high heels, men also fall victim to wearing shoes that are too narrow or too pointy for the shape of their feet.

So folks what do you say? Let’s just “shoe “ a little common sense when buying and wearing shoes. Save those high heeled and pointy shoes for the weekend.
Rob Kosofsky D.P.M.