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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