- Morton Neuroma
- Big Toe Arthritis
- Claw Toe
- Hammer Toe
- Minimally Invasive Bunion Correction Surgery
- Toe & Forefoot Fractures
Morton Neuroma
Definition: A Morton neuroma is a thickening of a nerve due to irritation and entrapment that most commonly occurs between the third and fourth metatarsals. It can be caused by anything that puts pressure on the nerve including pointed shoes, high heels, repetitive impact to the ball of the foot (running), or injury or trauma to the region.
Symptoms: Patient’s often experience tingling, burning pain or numbness between the third and fourth metatarsals near the toes. Symptoms often begin gradually and worsen overtime. Permanent nerve damage can result if left alone.
Diagnosis: A Morton neuroma is often diagnosed based on the patient’s symptoms and physical examination alone. Often a classic clicking sensation (Mulder’s click) is elicited when squeezing the metatarsal joint and palpating the interspace. Ultrasound and MRI can also be used to confirm the diagnosis.
Conservative Treatment: Shoes with a wide toe-box should be worn and a metatarsal pad can be placed in the shoe to reduce pressure on the area surrounding the neuroma. If symptoms persist an injection of steroid and lidocaine can be given which usually provides 3 months of pain relief.
Surgical Treatment: Surgery involves making an incision on the top of the foot and removing a small portion of the nerve including the neuroma.
How long will the surgery take? Will I be under general anesthesia?
You will receive a regional nerve block prior to surgery which will make your foot numb and eliminate all pain in the foot for 12-24 hours. You will receive light sedation during surgery but will not need general anesthesia. The surgery is an outpatient procedure and typically takes 15 minutes to complete. You will stay in the recovery room for observation for about 30 minutes after your surgery.
Can I walk after surgery?
You will need to use crutches for the first 12-24 hours after surgery until the nerve block has worn off. After the nerve block has worn off you may walk in a post op sandal for the first 2 weeks and then transition to regular shoes after that.
When will my stiches come out?
You will have a follow up visit 2 weeks post-operatively and your sutures will be removed at that time. For the first two weeks following your surgery you will need to keep the incisions and soft dressing dry by covering the foot with a sealed plastic bag when you shower.
Big Toe Arthritis
Definition: Hallux rigidus is a condition in which the first metatarsophalangeal (MTP) joint has increased stiffness and limited great toe extension due to arthritis in the joint. Of all the arthritic conditions in the foot, arthritis of the first MTP joint is the most common.
Symptoms: Hallux rigidus causes great toe pain, stiffness and often a prominent, irritating bump of the top of the first MTP joint. Pain is usually greatest during the “push off” phase of gait when the toe is most extended. There may also be redness, warmth and tenderness with pressure over the joint.
Diagnosis: The diagnosis of hallux rigidus is achieved by taking a patient’s history, preforming a physical exam and XRs which demonstrate joint space narrowing and arthritic changes of the first MTP joint.
Conservative treatment: Conservative management begins with shoe modification with a cushioned, rocker bottom sole and over the counter orthotics with a first ray post to assist the toe-off phase of walking or running. Oral anti-inflammatories and steroid injections into the joint can help to minimize joint pain. These treatments are aimed at controlling symptoms but do not alter the progression of the disease.
Surgical treatment: Several surgical options exist for the treatment of hallux rigidus. The option chosen will depend upon the extent of your arthritis, degree of deformity in the toe and amount of preserved range of motion in the joint. 1) Bone spur removal (chielectomy): for mild arthritis removing bone spurs at the top of the joint creates more space for the toe to bend upwards and reduces pain during the push off phase of gait. 2) Arthrodesis (joint fusion): this is considered the “gold standard” for eliminating pain caused by hallux rigidus. In this procedure, the damaged cartilage in the first MTP joint is removed and the two bones are fitted together with a plate and screws so they can grow together and become one bone. Movement of the big toe is restricted with this technique but most patients still remain active. 3) Joint resurfacing (interpositional arthroplasty): this technique uses a synthetic cartilage implant plug as a spacer in the joint to limit contact on either side of the joint. The implant can be converted to a fusion later if it fails. This is a newer procedure with less long term data, but studies have shown it to be as effective as a fusion in relieving pain while still maintaining range of motion.
FAQ
How long will the surgery take? Will I be under general anesthesia?
You will receive a regional nerve block prior to surgery which will make your foot numb and eliminate all pain in the foot for 12-24 hours. You will receive light sedation during surgery but will not need general anesthesia. The surgery is an outpatient procedure and typically takes 45 minutes to 1 hour. You will stay in the recovery room for observation for about 30 minutes after your surgery.
Can I walk after surgery?
Your weightbearing instructions after surgery will depend on which technique was used. In all cases you will need to use crutches for the first 12-24 hours after surgery until the nerve block has worn off. If a chielectomy or interpositional arthroplasty was preformed you may begin walking in a post op sandal after the nerve block has worn off. In the case of a fusion you will need to heel weight bear only in a post op sandal for the first 6 weeks. After six weeks you will usually be allowed to start flat foot weight bearing in a regular shoe.
Claw Toe
Definition: Claw toe is a toe deformity in which the toe bends upward (extension) from the joints at the ball of the foot (metatarsophalangeal joint) and bend downward (flexion) at the middle joint joints toward the ground. These arise from a variety of soft tissue injuries and are often related to underlying medical or neurologic conditions.
Symptoms: claw toe deformity as described above. These deformities are flexible in the beginning but get worse without treatment and may progress to a permanent deformity. Corns and calluses can form on the top of the toe and ball of the foot.
Diagnosis: Diagnosis of this condition is made with history, physical examination and x-rays if needed.
Conservative treatment: Conservative management includes wearing comfortable shoes with a spacious toe box, avoiding tight shoes and high-heels. Toe exercises and stretching can also be beneficial. Taping the toes and use of a metatarsal pad can also be used to alleviate pressure on the ball of the foot.
Surgical treatment: Surgical treatment for claw toes includes lengthening the flexor tendons in the toes, shortening the bones in the toes and temporarily inserting at steel K wire to keep the toe in correct position while healing occurs.
Surgical FAQs
How long will the surgery take? Will I be under general anesthesia?
You will receive a regional nerve block prior to surgery which will make your foot numb and eliminate all pain in the foot for 12-24 hours. You will receive light sedation during surgery but will not need general anesthesia. The surgery is an outpatient procedure and typically takes 30 minutes to complete. You will stay in the recovery room for observation for about 30 minutes after your surgery.
Can I walk after surgery?
You will need to use crutches for the first 12-24 hours after surgery until the nerve block has worn off. After the nerve block has worn off you may flat foot weightbear in a post op sandal. If a K-wire is used you will wear the post op sandal for 6 weeks. Otherwise you may transition to regular shoes when you feel comfortable.
When will my stiches come out?
You will have a follow up visit 2 weeks post-operatively and your sutures will be removed at that time. For the first two weeks following your surgery you will need to keep the incisions and soft dressing dry by covering the foot with a sealed plastic bag when you shower.
Hammer Toe
Definition: A hammertoe is a bending deformity of the middle joint in the 2nd, 3rd or 4th toe caused by a muscle/tendon imbalance between the flexors and extensors of the toe.
Symptoms: Due to the bending deformity the middle joint rubs against shoes or the tip of the toe presses into the ground. A corn or callus often develops over these points of pressure and friction. Inflammation, redness and a burning sensation can occur in the toe. Hammertoes gradually worsen overtime.
Diagnosis: History, physical exam and x-rays will be used to make your diagnosis.
Conservative treatment: Conservative management is aimed at reducing symptoms but will not correct the deformity. These include padding the corn or callus, taping or splinting the toe, wearing shoes with a deep, roomy toe-box, and using oral NSAIDs.
Surgical treatment: the most common surgical treatment for hammertoe correction is fusion of the proximal interphalangeal (PIP) joint. This is done by cleaning out the joint and fixing the two bones together with a K-wire. The k-wire remains in place for 6 weeks and is then removed in clinic. A screw can also be placed across the joint instead of using a wire.
FAQ:
How long will the surgery take? Will I be under general anesthesia?
You will receive a regional nerve block prior to surgery which will make your foot numb and eliminate all pain in the foot for 12-24 hours. You will receive light sedation during surgery but will not need general anesthesia. The surgery is an outpatient procedure and typically takes 30 minutes to complete. You will stay in the recovery room for observation for about 30 minutes after your surgery.
Can I walk after surgery?
You will need to use crutches for the first 12-24 hours after surgery until the nerve block has worn off. After the nerve block has worn off you may flat foot weightbear in a post op sandal. If a K-wire is used you will wear the post op sandal for 6 weeks. If a screw is used you may transition to regular shoes when you feel comfortable.
When will my stiches come out?
You will have a follow up visit 2 weeks post-operatively and your sutures will be removed at that time. For the first two weeks following your surgery you will need to keep the incisions and soft dressing dry by covering the foot with a sealed plastic bag when you shower.
Minimally Invasive Bunion Correction Surgery
Definition: A bunion, also known as hallux valgus deformity, is caused by a lateral deviation of the great toe towards the second toe with a painful bump at the base of your big toe (metatarsophalangeal joint). The deformity affects women 9 out of 10 times and is commonly caused by wearing tight, narrow shoes.
Diagnosis: Your bunion will be diagnosed by taking a medical history, and performing a physical examination to assess the extent of misalignment and damage to the soft tissues. We will order standing X-rays of your foot to access the severity of the bunion and deformity of the toe joints.
Treatment: Conservative management can be considered to possibly alleviate symptoms and delay deformity progression. However, surgical intervention is the only way to correct the existing deformity.
Conservative options include:
- Shoe modification: low-heeled shoes with a wide toe box
- Orthotics to improve support and alignment
- Medial bunion pads to prevent irritation
- Ice applied after activity to reduce inflammation
- Analgesics: acetaminophen or NSAIDs
Surgical Intervention: Dr. Davis is well known for his success with minimally invasive bunion correction surgery using a technique called a Chevron and Akin osteotomy. The minimally invasive technique allows the surgery and correction of the 1st metatarsal and proximal phalanx (great toe) alignment to be preformed through 4-5 keyhole incisions. This allows for minimal scar tissue formation, less post-operative pain, less swelling, better cosmetic results and faster healing time. There is also no damage to the tissues crossing the big toe joint which reduces a traditional complication of joint stiffness. 2 bone cuts and 3 screws are used during the corrective surgery.
To watch a video of the surgical technique please click here:
FAQ:
How long will the surgery take? Will I be under general anesthesia?
You will receive a regional nerve block prior to surgery which will make your foot numb and eliminate all pain in the foot for 12-24 hours. You will receive light sedation during surgery but will not need general anesthesia. The surgery is an outpatient procedure and typically takes 45 minutes to 1 hour. You will stay in the recovery room for observation for about 30 minutes after your surgery.
Can I walk after surgery?
You will need to use crutches for the first 12-24 hours after surgery until the nerve block has worn off. You will then be able to weight bear through the heel in a post op sandal that is given to you at the time of the surgery. You will heel weight bear for 3 weeks and then may transition to flat foot weight bearing as your pain allows.
When will my stiches come out?
You will have a follow up visit 2 weeks post-operatively and your sutures will be removed at that time. For the first two weeks following your surgery you will need to keep the incisions and soft dressing dry by covering the foot with a sealed plastic bag when you shower.
When can I wear regular shoes?
You can begin to wear regular shoes between 4 and 6 weeks post operatively according to your comfort.
Toe & Forefoot Fractures
Definition: A fracture is a break in a bone and can be caused by either trauma or stress on the bone. A traumatic fracture can result from a fall, a direct blow or a high impact. A traumatic fracture can be displaced (misaligned) or nondisplaced. Stress fractures commonly occur in the metatarsals, the bones that extend from the toes to the middle of the foot. A stress fracture is a hairline crack in the bone surface that often occurs after abrupt increases in exercise or changes in training surfaces. An abnormal foot posture, a tight Achilles, osteoporosis and improper shoe wear can predispose someone to a stress fracture.
Symptoms: Symptoms of a toe or forefoot (metatarsal) fracture include pain and swelling. Bruising is present with a traumatic fracture but not often with a stress fracture. There is often pinpoint pain at the fracture site when pressed. Pain with walking is common.
Diagnosis: Diagnosis of a toe or forefoot fracture is made with history, physical exam and x-rays. In some cases a stress fracture may not be visible on x-ray and an MRI or CT scan may be needed.
Treatment: As long as a fracture is not significantly displaced it will usually heal well on its own without surgery. For toe fractures a post-operative sandal or walking boot is worn and the affected toe is buddy taped to an adjacent toe. If the fracture is displaced and will not heal in a correct alignment surgical intervention is needed and K-wires are often used to keep the toe in proper position as the bone heals.
For nondisplaced metatarsal fractures including stress fractures a walking cast or walking boot is worn for approximately 6 weeks. For cases where there is significant displacement of the bone surgery is needed to realign the bone. A metal plate and screws or K wire are used to hold the bone in proper position while it heals.
