swollen hammertoe surgery

by lesia
(camilla , ga)

I had surgery done on my right foot 2nd toe next to big toe the doctor pull the pin out and it hurt so bad and still hurt and I notice it is swollen in lower part of my toe and turning to the right its not straight and the doctor say the xray is fine every time I go

RESPONSE

Hi Lesia,

I do not want to play referee here between you and your doctor, but if you are concerned about how your toe appears, in spite of the x-ray, then you need to voice your concern to the doctor.

I am responding to your post because I think it is important to point out a couple of potential issues regarding hammertoe surgery, particularly on the second toe.

I will start by saying that is not uncommon for the second toe to swell after hammertoe surgery, more so than the other toes. Typically the swelling will be where you describe and noted by the red circle on the attached diagram.

Why does the second toe swell more than the other toes after surgery? It has always been my understanding that this is due to a problem with the lymphatic (drainage) system of the foot in this area. Arterial blood flow brings oxygen and nourishment down to the toes, and the venous and lymphatic systems return blood back to the heart and remove metabolic waste.

If there is a disruption of this return flow, say as a result of surgery, then the toe will swell.

Any surgeon who routinely does hammertoe surgery will tell you that the second toe has a propensity to swell more than the other toes.

Is this swelling permanent? It can be. In my practice, as soon as I remove the sutures I have my patients start wrapping the toe with a material known as one inch Coban. It looks like Ace bandage material in a roll of tape. I have them apply the Coban first thing in the morning when the toe is its least swollen and leave it on continuously until the next day. The only time the toe is not wrapped is when the patient showers.

In most cases this helps but I have to tell you there are still instances where even with wrapping the toe, the toe remains permanently swollen.

There are other factors to consider as well in whether or not the toe will remain swollen. Patient compliance is one factor. Is my patient actually following instructions and wrapping the toe every day? Another factor is patient activity. Not everyone is in a position to sit with their foot elevated all day; people have jobs and other responsibilities that require them to be ambulatory as soon after surgery as possible. Patient age and related health issues may also be a factor.

Believe it or not, but weather conditions may also play a role. I find that patients who have this type of surgery in hot, humid weather tend to have more swelling than those that have the procedure done in cold weather. The simple reason is that humidity tends to make feet swell and in those who have just had foot surgery, the humidity just further adds to the swelling that is normally associated with surgery and the healing process.

The question then becomes how do you as the patient approach this problem. Certainly, in an ideal world you would want your toe to heal and look as normal as possible. I understand that. However, that may not happen for you, so what you need to ask yourself is whether or not the surgery at least resolved the pain you were experiencing in the toe prior to surgery. Hopefully, you consented to the surgery because you were having pain and not because "you did not like the way your toe looked when you were barefoot" as I and most foot surgeons do see patients who come in simply because they do not like the way their toe looks in sandals or at the beach.

If the surgery did resolve your pain and in spite of the fact that the toe may remain somewhat swollen, then you should consider the surgery a success.

My suggestion would be to discuss this with your surgeon. Ask he or she if you could start wrapping the toe, even possibly consider physical therapy in an effort to help reduce the swelling. Keep in mind, the sooner you start this, the better the potential results.

I should also mention that since you state the toe is pointing in the wrong direction, taping, particularly early in the healing process, may help straighten the toe. This statement is a general statement, as I would have to actually see the x-ray to determine how bad the "deviation" is and whether or not taping would be of any value for this part of your problem.

Another concern of mine in regards to your swelling is the possibility of infection. Since you had a pin in your foot there is always the chance that an infection may ensue. Insertion of wires, pins, screws, etc. even though they are sterile, does increase the possibility of infection simply because while they are in especially when they are exposed through the skin, increase the chance that bacteria will seep in through the opening in the skin and cause infection.

Hopefully, you have a capable surgeon who is aware of that possibility and would recognize the possibility as the cause for your swelling.

In conclusion speak with your surgeon, if you are not satisfied with the answers, then seek out the opinion of another foot surgeon in your area.

Marc Mitnick DPM
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