Nancy Valrose wrote:
-------------------------------
I read your reply to Kim and I was hoping you could advise me as well. I had Hammertoe surgery 7/12/04 in Lake Forest, Il. I respected the surgeon, he had operated on my bunions twice over the last 20 years and I had a great result. My hammertoes (2nd toe on both feet) had a k-wire inserted. The results were not good. Both toes sit up too high. My doctor seemed surprised by the results but did say maybe we could do a "stab Procedure". I went to two other doctors for their opinion. One said he thought they looked good and hammertoes were difficult to correct. He was willing to cut the tendon but said I may get a drop toe. I did not go back! 2nd doctor said he could make an incision and lengthen the extensor tendon. The recovery sounds very lengthy. How do I know if he is a good doctor? If this is the correct procedure? Please help! Where are you located?
Nancy
***********************************************************
DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
***********************************************************
In my experience in such conditions, the prognosis for a satisfactory correction by either extensor tenotomy or tendon lengthening, either through a stab incision or as an open procedure would depend on whether or not tightness of the tendon was the only cause for the toe's riding high. A physical examination, of course, especially aimed at how well the toe can be manipulated into a more correct position, and what force is necessary to accomplish that would be necessary to have a good idea as to if this be the case or not, and how successful such a revisionary procedure might be.
I would first be interested in knowing why the pin was required in the first place. K-wires are generally employed for two main reasons in hammertoe surgery:
1. You may have had a fusion procedure, in which case the K-wire was employed to stabilize the toe and immobilized the area where the joint was intended to become fused until the bone healing was complete.
2. It may have been felt before or during surgery that the toe would not sit down properly without some help and a K-wire was placed through the phalanges of the toe and into the metatarsal to hopefully avoid the problem of which you now complain. If this were the case, too early a removal of the K-wire may have resulted in the toe's return to a less than optimum possition.
In either case, it is likely the there is more to this toe's sitting up too high than simply a tight extensor tendon, though that may have been the original and primary underlying cause. Most likely there is now also fibrous scar tissue about the metatarsal-toe joint which might tend to keep the toe in its present position even if a tendon procedure were done, unless that scar tissue were also incised or excised. Also, it is possible that you have what is commonly called a "sausage" toe, not terribly uncommon after such surgery. This is thought to be caused possibly by poor post-surgical lymphatic drainage, venous congestion, less than gentle handling of tissues and/or scar tissue formation, and when first noted, I generally "milk" the toe with a circular, well-controlled pressure dressing. But that has to be done very early in the game.
My real issue is that this surgery was done 10 months ago, and I would think that there was probably some early evidence that the toe was not sitting down as it should. If aggressive non-surgical action were taken in a timely fashion (and I don't know that it wasn't) the problem may have eventually have been corrected. Such problems as you are encountering are not uncommon in toe surgery, but the early recognition of such situations and the taking of immediate and often aggressive action is key in mitigating them. Ordinarily, I would have ascertained as to whether the metatarsal-toe joint was tending toward dorsal subluxation. It might then have required manipulation under local anesthesia to break adhesions and scar while they were still friable, or sometimes simply taping the toe in exaggerated plantar flexion, generally until the toe will droop somewhat when the tape is removed will do the job. (continued healing and the inevitable scar tissue will most always bring the toe back into a good positon and overcome any residual drooping). The key to the long-term success to any of these revisions is constant assessment, follow-up and fine-tuning of any attempted correction until the problem is either adequately overcome or a decision to perform further revisionary surgery is made. The post-operative period after ANY surgical procedure is generally a terribly valuable time when real problems can be detected in their earliest stages and addressed, and when micro-corrections can be done which are frequently are not possible later.
But you went to one doctor who said the toe looked pretty good, so I don't know whether your assessment is overly critical or if there is actually a problem other than the fact that the result may not perfect.
In regards to the doctor who told you that you may have a dropped toe after re-surgery . . you should be so lucky. If given a choice between a toe which rides too high and on which droops . . personally I'll take the "drooper" every time. Remember . . surgery frequently does not return a body part to its factor specs condition, but is aimed at making a bad situation better, not necessarily perfect. Body parts are not interchangable pieces of inanimate machinary and cannot be treated as such. |
