Name of the Procedure:

Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe

Common Name(s):

Toe osteotomy, Proximal phalanx osteotomy, Hallux osteotomy

Summary

This surgical procedure involves making precise cuts in the bone of the first toe (the big toe) to correct deformities, improve alignment, or reduce the length of the toe. It is often performed as a separate procedure and aims to improve function and relieve pain.

Purpose

The procedure addresses deformities and malalignments of the big toe, which can lead to pain, difficulty walking, and wearing shoes comfortably. The primary goals are to correct the toe's alignment, reduce pain, and improve the overall functionality of the foot.

Indications

• Severe bunion (hallux valgus) causing pain and functional limitations
• Hallux rigidus (stiff big toe) affecting movement and causing pain
• Toe deformities from arthritis, injury, or congenital conditions
• Abnormal toe length causing discomfort or difficulties

Preparation

• Patients may need to fast for several hours before the surgery.
• Medication adjustments, especially blood thinners, may be necessary.
• Pre-operative assessments could include X-rays and blood tests to plan the surgery.

Procedure Description

1. The patient is administered anesthesia, which may be general or local with sedation.
2. An incision is made to access the proximal phalanx of the first toe.
3. The surgeon makes precise cuts in the bone to shorten, correct the angular or rotational deformity.
4. The bone segments are then realigned and fixed in place with screws, pins, or plates.
5. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This surgery is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Nonunion or malunion of the bone
• Recurrence of the toe deformity
• Blood clots

Benefits

• Relief from pain and discomfort
• Improved ability to walk and wear shoes
• Enhanced quality of life
• Correction of toe deformities leading to better foot function

Recovery

• Pain management usually involves prescribed pain relievers.
• Patients may need to keep weight off the foot for several weeks.
• Physical therapy may be recommended to restore movement and strength.
• Follow-up appointments are necessary to monitor healing.
• Recovery typically takes several weeks to a few months, depending on the individual’s health and adherence to post-op instructions.

Alternatives

• Conservative treatments like orthotics, physical therapy, or medications
• Less invasive surgical procedures, depending on the severity and type of deformity
• Pros of these alternatives include lower risk and shorter recovery time, while cons may include less effective correction and potential need for future surgery

Patient Experience

• During the procedure, patients under general anesthesia won’t feel or remember anything, while those with local anesthesia and sedation may be relaxed and comfortable.
• Post-surgery, there may be pain, swelling, and discomfort, which can be managed with medication and ice.
• Initial mobility will be limited, and crutches or a boot may be needed to prevent weight-bearing on the operated foot.
• Gradual improvement in symptoms and function is expected within several weeks to months post-surgery.