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Swollen toe after hammertoe surgery

by Jo
(Galloway,Ohio)

My second toe on my right foot is still swollen after my hammertoe surgery 6 months ago. The foot doctor said to massage it everyday, but after all this time it is still swollen and has a slight hump even though I did all that was said to do after he surgery. I really don't want to go through another surgery on this toe, I had a pin at the end of my toe for three weeks and had to stay off my foot for 3 weeks. Please give me some idea if this is normal!!!! Thank you


RESPONSE

Hi Jo,

A swollen toe, particularly the second toe is much more common after hammertoe surgery than you would think.

Although toes two through five all have the potential to stay swollen after surgery, the second toe seems to be the most prevalent. I have always thought it has something to do with the lymphatic system (drainage system) of the foot and for some reason the second toe does not drain well.

Surgery to any part of the body is a "trauma" and the way the body deals with trauma is to increase the blood flow to the area increasing nutrients to help the area heal.

Therefore swelling is normal after hammertoe surgery but between poor drainage that was just noted and the fact that the foot is constantly in a dependent position where gravity works against drainage, the toe may stay swollen.

The fact that we are in the middle of summer does not help the fact either, as increased humidity also tends to make the feet swell more so than in cooler weather.

This is one of the potential pitfalls of hammertoe surgery and I make it a point to tell my patients before hand that this could happen.

The fact that you had a pin in the toe has no real bearing on the degree of swelling.

When I do a hammertoe surgery I keep the toe wrapped under compression both during the period before the sutures come out and afterwards as well. There is a product called Coban which is sold in a one inch roll and is kind of like ace bandage material in that it stretches. I have my patients wrap the affected toe first thing in the morning and leave it on all day. I will say that even in spite of wrapping the toe (assuming my patient is compliant) there are those whose toe still ends up swollen.

The question now becomes what are you going to do about it?

More surgery is not the answer. Quite frankly there is no procedure that I know of that will reduce the swelling.

Since you are at the six month point it may or may not be too late to get the swelling down by physical therapy. You could certainly ask your doctor about the possibility and see what he or she says.

I guess the real question becomes one of whether or not the toe hurts, particularly in a closed shoe.

Although you may not be happy with the appearance of the toe and I should say there is a chance some of the swelling may subside over time, particularly if you have some aggressive treatment, if the toe no longer hurts when in shoes than it could be considered a successful surgery. You may not agree with that due to the appearance of the toe but it is one way to look at what you are left with.

I would suggest you have another conversation with your surgeon, or even go for a second opinion and see if there is anything else you can do.

Marc Mitnick DPM
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Comments for Swollen toe after hammertoe surgery

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Oct 03, 2017
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Swollen toe post surgery
by: Teresa

I had bunion & second & third hammertoe,surgery aug 16th, pins were pulled Sept 27, 5 days ago, third toe, looks like it is curling down ward & is very swollen still, is it possible the bone fractured on removal of the pin, it didn't hurt too bad to have pins pulled, but the next 2 days after were bad, did a lot of icing & elevating...It seems my ankle, calf & across top of foot is still swelling a lot when on it for more than an hour. Any advice would be appreciated.
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The best advice is to make your surgeon aware of your issues and let he or she decide if anything need be done.

Marc Mitnick DPM

Sep 30, 2017
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Post op boot TOO heavy!?!
by: Pamela

Bunion removed 12 yrs. ago, which ultimately proved to be an over correction. I am now 6 weeks post hallux varus - big toe fusion with 4 pins (2 in each) in 2nd and 3rd Hammer toes. Stitches (25) removed at week 2. Pins to be removed next week. My question is about the boot the surgeon sent home with me to begin wearing - 25% weight increasing to 100% over next 2 weeks. The boot is TOO hard and heavy for me to walk! My husband and I have readjusted in every way possible! It has totally bruised my shin, and in attempt to sit with boot on I can not elevate foot at all because of the weight. Doctor's PA offered no solution. Is this tall, heavy boot my only option? Are there lighter weight boots for small frame, small boned woman? Please help!
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There are shorter boots available but you need to speak to your surgeon before you make any changes to his instructions, as you do not want to jeopardize your healing.

Marc Mitnick DPM

Jul 01, 2017
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4th Toe Swollen 1 year later
by: Chris

I had hammertoe surgery on 4th toe 14 months ago and I still have swelling. It's very painful. Surgery was done to stop pain from fractured toe that was still painful after 2 years so I've had this pain for 3 years now. The surgeon did not instruct me to do any taping or PT or anything, he said I could resume normal activity. When I returned with pain he said it looked fine and to give it more time. I've since seen a new doctor who has suggested some stretching but that hasn't seemed to help.
I'm desperate to walk again without pain. I'm only 38 and in great health otherwise. Than you for any advice.
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It is hard to give advice without seeing you or x-rays. In general terms, if you had an arthroplasty, where a section of bone was removed to straighten the toe, and you are still in pain, then you may have to consider a fusion where the bones are fused together so they do not move.
Prior to consenting to further surgery, you might also entertain a cortisone injection in the area of pain, if you have not already had one.
Sorry, cannot be more specific.
Marc Mitnick DPM

Apr 23, 2017
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SWELLING AFTER 7 WEEKS POST SURGERY
by: LORETTA

How can I minimize the swelling and pain in my toes 7weeks after surgery? Some days the swelling is worst than others. I can't wear a shoe very long maybe up to two hours and then only tennis shoes. I am open to ANY and ALL suggestions that have proven helpful to keep the swelling down and END THE PAIN in my toes. I have a return visit with the doctor which is 6 weeks after the removal of two pens in two of the three toes operated on. I have an insert in the second toe. My doctors visit is in 3.5 weeks away and I need to end the pain and reduce swelling now.
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The better move would be to call your surgeon's office and ask to come in sooner.
Swelling and pain are common after hammertoe surgery, up to a point, so if your pain is beyond the expected normal, your surgeon should be made aware of it.
The sooner something is done, the less likely you will be left with residual problems.

Marc Mitnick DPM

Mar 10, 2017
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different toes
by: Stefany

Two months ago, I had hammertoe surgery on all my toes, except the big toe. I was happy with the results, except for my second toe being the same length as my big toe. My toes were extremely swollen, but I was told this is normal and would decrease gradually. Nevertheless, I was happy with the results. All my toes are now straight and I was getting used to the new wider, chubby looking toes until I had the right foot done a week ago.

Now it turns out I have less swelling, and my second toe is smaller than my big toe and all my other toes look smaller in width and slightly length compared to my left foot.

So right now, I'm terrified that once the swelling goes down on my right foot. The size discrepancy will be too noticeable and I will have to get revision surgery to lessen the second toe slightly to match the other foot, and perhaps lengthen the pinky. Additionally, the toes on my left don't hurt anymore unless I touch them to stretch or bend them; so I don't know if they will get narrower.

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Be careful when considering further revision surgery with the hopes of getting your toes to "match". It is not always possible. The more surgery you have on toes, the greater the chance there will be permanent problems,like pain and permanent swelling.

Down the road, if your surgeon recommends revision surgery, be sure to get a second opinion.

Marc Mitnick DPM

Feb 07, 2017
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6 wk post op hammertoe surgery
by: Maria

I had hammertoe surgery on both feet 6 weeks ago.On my left foot I had the 3 and 4th toe with k-wire.This is my 3rd surgery and the last one was done 2004. I developed bone growth on these two toes and a lump on side of my 4th toe. This problem developed years ago and became a problem in the last two years. This is why I had to have another surgery.I injured my 3rd&4th toe in the shower while shaving my legs.😞 This happened 2/4/2017. I hit the tip of my toes and the pins were pushed in. It was very painful but after awhile it went away. Later that evening,I begin having excruciating pain,redness/warmth on toes/top of foot,and a lot of swelling. The next day I ended up going to UC. X-ray was done.The MD indicated that pins look intact and it was probably bruised.🤔 The next day it was a lot worse. I ended up seeing my surgeon and he removed the wire and gave me antibiotics/Mobic. I was told that it will get better and the swelling will go down within time. I would like to know....When you have excessive swelling,why do your toes look shorter? Is it because of the swelling? I was told it's because of the swelling and the x-rays look fine and no changes in bone.I was so happy with the results a few days ago. Everything look good,until the day I hit my toes.My surgeon told it's all the swelling and that's why they look short. But once all the swelling goes down,it will look just like it did the day before I hit my toes. I'm so paranoid and just want a 2nd opinion.
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Making the assumption that the swelling is from the trauma of hitting the pins and not from any infection, one could assume the swelling will subside.
The only suggestion I would make, if it is not already being done, is to ask your surgeon if the swollen toes should be wrapped with a compression dressing like coban, to help keep the swelling down.
One of the problems with swollen toes, after hammertoe surgery, is that they can swell and then stay swollen indefinitely. By wearing a compression dressing, you help mitigate that possibility.
Keep in mind, the more procedures you have done on the same toes, the greater the chance of permanent swelling.
I do not know what type of hammertoe procedure you had performed, but in the most common procedure, a small piece of bone is removed. That is what might make your toes appear shorter, not so much the swelling.

Marc Mitnick DPM

Jan 15, 2017
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Numness
by: Christina

My 2nd toe is numb am very swollen . Pin came out 2 weeks ago and I can not feel this toe. Is this normal. I'm 4 weeks post op bunion and hammer toe surgery.
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Swollen toes particularly the second toe is very common after hammertoe surgery, but it needs to be addressed, otherwise you run the risk permanent swelling. See your surgeon.
Marc Mitnick DPM

Dec 27, 2016
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Second toes still have some swelling after six months
by: Peggy

I do not have any pain in my toes; however they still look swollen and do bend like the other toes. I'm not sure if this is normal. Hammertoe surgery was done on both feet, second toe on each foot at the same time. I'm disappointed in the look of my toes. The second toe on both feet is shorter than the first and third toes and crooked! This comment is to let one know what to expect with hammertoe surgery.

Dec 11, 2016
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Swelling after surgery
by: Jennifer

I had hammertoe surgery just over 2. weeks ago. Still swollen and painful. I am able to get on a running shoe but is so painful after a short time. It still hurts to walk. I wish I didn't have the surgery. Should I try the colban wrap? I do have a device to put on toe for swelling. I did wear it all day and my toe hurts. When I take it off it feels better. I teach tennis so am supposed to wear while teaching. I guess I keep doing so. Any other suggestions would be appreciated. Ugg boots are tolerable 😊
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Hi Jennifer,
You should run all these questions by your surgeon as he or she is ultimately responsible for your care.
One of the reasons your toes are swollen is because you are on them too much. I cannot believe you are attempting to teach tennis two weeks after hammertoe surgery.
Keep in mind, if the toes stay swollen for too long, they will remain permanently swollen. Speak to your surgeon for better guidance.
Marc Mitnick DPM

Dec 16, 2015
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swollen second toe
by: TODD

I feel SO much better after reading this.....thank you. I'm yet another person with an ugly swollen second toe several weeks after surgery.....much more swollen than it was weeks ago.

Jul 10, 2015
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Thank you Dr. Mitnick
by: Anonymous

Thank you Dr. Mitnick for your quick response and also for the explanation in the original post that the swelling in my toe could be caused by problems with the lymphatic system. My doctor said my x-ray looked perfect but if it still was swollen in another 3 months to come back for an MRI. He didn't know why it might still be hurting. I appreciate you having this website.

Jul 10, 2015
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I'm doing what Dr. Mitnick suggests
by: Anonymous

My 4th toe is still swollen and hurts 6 months after hammer toe surgery. I started to wrap my toe with coban this week like Dr. Mitnick suggests. It makes it feel so much better all day but I found if I leave it on when I go to bed, the toe aches and I have to take it off. I wonder why it hurts when I leave it on in bed?

RESPONSE
Not sure while it hurts at night, but, it should be removed at night simply because the purpose of coban is to keep the toe from swelling during the course of the day.
In the morning the toe will generally not be as swollen.
This is something that you will not have to do forever, but I would certainly continue through the summer months and stop once the weather turns cold.

Marc Mitnick DPM

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