Name of the Procedure:

Correction, cock-up fifth toe, with plastic skin closure (e.g., Ruiz-Mora type procedure)

Summary

A surgical procedure to correct a deformity of the fifth toe often referred to as a "cock-up toe." It involves realigning the toe to its natural position and closing the surgical area with plastic skin closure techniques to ensure optimal healing.

Purpose

The procedure addresses the presence of a cock-up deformity in the fifth toe, which can cause pain, difficulty in walking, and problems with footwear. The main goals are to alleviate pain, improve foot function, and enhance cosmetic appearance.

Indications

• Presence of a visible cock-up deformity of the fifth toe
• Pain or discomfort due to the deformity
• Difficulty in wearing shoes or engaging in daily activities
• Non-responsive to conservative treatments like padding, orthotics, or physical therapy

Preparation

• Patient may be instructed to fast for a certain period before the surgery.
• Adjustments to regular medications may be needed, especially blood thinners.
• Preoperative assessments might include blood tests, a physical exam, and imaging studies of the foot.

Procedure Description

1. The patient is given local or regional anesthesia to numb the foot, and sometimes sedation.
2. A small incision is made over the fifth toe.
3. The tendons, bones, and soft tissues are realigned to correct the toe's position.
4. Excess skin or tissue may be removed.
5. The surgical site is closed with a plastic skin closure technique, utilizing fine sutures or skin adhesives to minimize scarring.
6. A sterile dressing is applied to the site.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The surgery is usually performed in an outpatient surgical center or hospital.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Nurses
• Anesthesiologist or anesthesia nurse

Risks and Complications

• Common risks: infection, bleeding, pain at the surgery site
• Rare risks: nerve damage, blood clots, poor wound healing, recurrence of the deformity

Benefits

• Relief from pain and discomfort
• Improved ability to wear a variety of shoes
• Enhanced cosmetic appearance of the foot
• Better functionality and mobility

Recovery

• Post-procedure care includes keeping the foot elevated and using ice to minimize swelling.
• Dressings should remain dry and clean until the follow-up appointment.
• Restrictions on weight-bearing activities, with gradual return over weeks.
• Stitches usually dissolve or are removed within 1-2 weeks.
• Follow-up visits to monitor healing; physical therapy may be recommended.

Alternatives

• Non-surgical options include padding, orthotics, and footwear modifications.
• Pros: Less invasive, no surgery-related risks.
• Cons: Might not be effective for severe deformities, potential for less pain relief.

Patient Experience

Patients might feel discomfort and mild pain during the recovery period, which can be managed with prescribed medications. There may be temporary restrictions on activity, but most patients resume normal activities within a few weeks. Comfort measures like rest, ice, elevation, and compression can aid in a smoother recovery.