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What are the risks and benefits of surgical intervention?

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Dr. Robert Anderson

Any surgery has its risks and benefits, and it is very important for the patient and the physician to sit down with their physician to discuss those risks and benefits before pursuing surgical intervention. Now, not all patients are going to be able to undergo surgery on a foot deformity, or, in this case, a hammertoe deformity. There may be medical conditions that prohibit surgery, there may be certain medications, or inadequate circulation that may prohibit surgery, in which case, patients are best treated by non-operative modalities such as larger shoes or some type of sleeve on the toe itself. No matter how simple the surgery appears to be, there are always those risks of infection or wound healing problems, or recurrences, or failed metal implants or K-wires, so it is very important that the patient understands that before going to the operating room for any type of hammertoe correction.

Are there risks involved when having hammertoe surgery?

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Dr. Robert Anderson

Any surgical procedure has its own risks, and just correcting a simple hammertoe deformity is no different. There are always risks of infection or wound healing problems, recurrent deformity or broken implants. Again, we will offer patients the option of a MiToe™ implant or a K-wire when we do correct a hammertoe. We want the patient make sure the yunderstand those risks before we do a surgery. We want to ensure that they’ve exhausted all of their non-operative opportunities before surgery as well. It is important for the patient to understand that no matter how simple the procedure is there are always risks that may be associated.

What has been your experience and success using the MiToe™ implant?

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Dr. Robert Anderson

We’ve had an excellent track record of utilizing the MiToe™ implant in Charlotte where I practice. The implant has been out for nearly 2 years. It has been used in over 10,000 procedures with excellent success both in the short term and the long term. I have personally done literally hundreds of these implants , and I must say that my patients are very, very happy that they’ve had the implant placed rather than that of a K-wire.

What are the main benefits of the MiToe™ procedure?

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Dr. Robert Anderson

I think the patient will find a significant number of benefits by having a MiToe™ implant utilized for hammertoe correction over a K-wire. (beeping) Again, it is based on my experience, but I have found that cosmetically the toe just looks better – it has less swelling and maintains its position better than one in which the hammertoe was corrected with a K-wire, the K-wire was removed and the hammertoe came back, or created some long term swelling, or what we call molding effect. I find that it is not only one that is a cosmetically advantages, but also convenience – not having a pin sticking out the end of the toe that has to be removed in the office after 4 weeks. Being able to get back to shoes quicker. They can shower and swim quicker, is of significant importance to a number of patients. And I think the safety of the implant over K-wires is important to mention. I find that not having that risk of infection that is often created by having a retained implant is a tremendous benefit to a number of patients, whether they are those that are diabetic and have increased risk of infection or those that may have a total joint replacement in that same lower extremity where the toe is being corrected. We try to reduce that risk of infecting another implant by not having K-wire sticking out the end of the toe. Those are just a few of the reasons that the MiToe™ implant may be of benefit to patients coming into our offices.

How long will it take to get back to normal after a MiToe™ procedure?

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Dr. Robert Anderson

The question comes up, “How long will it take for me to get back to completely normal?” And, of course, that is different from one individual to another. How much surgery did you have? As I mentioned, we often do hammertoe deformity corrective surgery in addition to other surgeries, so your recovery may be prolonged due to the fact that you have had your bunion fixed or you have had other foot deformities corrected at the same time as when your hammertoe has been corrected. In general, we try to get patients back on their feet within the first several days. We try to get them back into their shoewear within the first 2-4 weeks, depending on swelling. Swelling in the foot can last for some time just due to the gravity effect of being on your feet all day can create some swelling concerns that may last for weeks and even into months. But, most of our patients are back to regular activity after an isolated hammertoe deformity correction by 4 weeks, and back to their dress shoe wear by 2-3 months

What are K-wires and how are they used?

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Dr. Robert Anderson

K-wires can be used for the correction of a hammertoe that is undergoing surgical correction. They are small, slender, stainless steel pin that are placed into one half of the bone and out the toe at the other end. And it basically holds the toe in good position, and it has been used for many, many years with relatively good results. But, again, that pin has to remain out of the end of the toe for subsequent removal. So, you have this pin hanging out of the end of the toe that may catch on socks, it may catch on the carpet. It runs the risk of getting loose and infected. And often times the surgeon will have to put a little ball or a rubber cap over the end of the toe to keep it from getting snagged, and that adds just more bulk and inconvenience to the patient.

What is the patient’s experience with K-wires like?

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Dr. Robert Anderson

K-wires in the correction of hammertoe deformity can certainly work. They’ve been used for years, and they can be successful. However, we have found over our years of experience that they do run the risk of infection; they do have a tendency to have more swelling. When the wire is removed from the toe, there is a significant risk of having a recurrent deformity – it may not be a recurrent hammertoe but a deviation of the toe from one side to the other. For that reason, we have found the use of a MiToe™ implant to be beneficial.

Why is the MiToe™ the best surgical option for patients with hammertoe?

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Dr. Robert Anderson

I believe that the MiToe™ implant is the best choice for maintaining correction of a hammertoe surgery because it provides long-term stability, and it maintains the correction despite what external forces may be on the toe, whether it be a recurrent bunion deformity or whether it is shoe pressure. Having that implant in the toe keeps that toe in whatever position you want. And , of course, it is a convenience to the patient, and decreases the risk of infection, which, is a concern for a number of patients, particularly when they have other medical conditions.

Why would you recommend MiToe™ to your patients?

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Dr. Robert Anderson

I recommend the MiToe™ implant for my patients undergoing hammertoe corrective surgery, because I think it offers not only convenience to the patient post-operatively with less swelling, less risk of infection than a wire will have, but also a return to a shoe quicker , allowing them to get back to their daily activities quicker whether it is work related ones or recreational.

What exactly is the MiToe™ implant?

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Dr. Robert Anderson

When we consider surgery for the hammertoe deformity, we’ll often times consider the use of the MiToe™ implant. People want us to describe – what is this implant – is there a concern about having this implant in my toe forever. And there really isn’t. It is a metal implant; it is a stainless steel implant. It has been used in similar conditions in the body for literally the last century with no concerns for long-term implantation. It is a small implant that is sized specifically for your toe. It has a threaded end and it has a barbed end that allows the surgeons to basically remove the deformity and then maintain the toe in proper position afterwards with secure fixation on both sides of that joint.

What is the typical recovery time after a MiToe™ procedure?

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Dr. Robert Anderson

The whole recovery process with the use of a MiToe™ implant is a fairly quick one, again assuming that we’re doing an isolated hammertoe. As I mentioned before, a lot of patients are having additional procedures done, which may prolong their recovery to some degree. But, if you’re talking about correcting an isolated hammertoe deformity with a correction and implantation of a MiToe™ implant, the recovery process really is quite easy, quite simple. Once, the stitches are removed at 2 weeks, we do allow the patient to return to a shoe that is accommodative – that has enough room to manage any residual swelling. They can increase their activity as quick as they like, whatever their symptoms allow. They can get back to work within a fairly short period of time. They can get back to their sport within a rapid period of time. So, again, the recovery process utilizing the MiToe™ implant is a fairly expeditious one.

How does the MiToe™ implant affect recovery vs. K-wires?

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Dr. Robert Anderson

The real benefit of utilizing the MiToe™ implant over K-wires is with that post-operative course. You can imagine having a wire stick out the end of the toe for a period of several weeks, not only runs the risk of infection, but becomes a real inconvenience. You have to be in a post-operative shoe or open-ended shoe for a longer period of time. It can delay your return to work, and it can just be a source of irritation. Besides that, you’re concerned about infection. With the MiToe™ implant in place, patients are allowed to shower quicker, they’re allowed to get back in their shoes quicker, which really means they’re back to work quicker.

What can the patient expect with the MiToe™ surgery?

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Dr. Robert Anderson

When a patient elects to proceed with surgery for correction of a hammertoe deformity utilizing the MiToe™ implant, it is really a smooth and fairly speedy process. We will usually pick a particular date to proceed to the surgery center or outpatient facility. They will meet with the anesthesiologist. They will have light sedation. They will usually have, what is called, an ankle block where the foot is numbed for a short period of time to allow the surgery to be performed. The surgery will often take 20 minutes, if it is just an isolated hammertoe that is being corrected. The way that I manage to patient post-operatively is with a small dressing that is placed around the toe and the front of the foot that is typically removed at about 1-2 weeks time. The patient is allowed to fully weight bear on the foot immediately utilizing some type of post-operative shoe or post-operative sandal. We typically remove any stitches that were placed by two weeks after the surgery and at that time, the patient is allowed to shower and even swim. Assuming that there is no wound healing issues and minimal swelling, we often times allow our patients to get into their accommodative shoe wear – athletic shoes, or clogs, or Crocs – even after that 2 week mark.

What is hammertoe and what causes hammertoe?

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Dr. Robert Anderson

When a patient feels as though they need surgery for their hammertoe deformity, it is important for the patient and the surgeon to sit down and discuss whether they are a good candidate for that correction. Obviously, they need to have skin that is of a condition that will heal with surgical intervention. They have to have adequate circulation, good pulses in their feet. We would tend to shy away from patients who have severe diabetes, or potentially some severe neurological problems, or other medical reasons or conditions that may prohibit surgery. Once we’ve determined that the patient is a surgical candidate – they have good pulses, good soft tissue and skin condition at the level of their toe to allow for surgical correction of their hammertoe deformity, then we would sit down and discuss the specific surgery and the use of the MiToe™ implant versus that of a k-wire.