Some people are reluctant to display their feet or to wear sandals because they have excessively long toes. They will avoid certain activities or social events because they are concerned about other’s judgments.

When one or two toes are longer than the adjacent toes, this may indicate several problems. Painful and unattractive corns or areas of redness can develop on the top or the tip of the particular toe. With some individuals, there can be changes of pigment color on the tops of the toe.

There are two different length patterns for toes. The most common pattern is a foot structure where the second toe is the longest. The less common pattern is the structure where the great toe is the longest toe. When a particular toe is straightened or shortened with either type of foot structure, there should be a small difference in length between one toe and the adjacent toes. Aesthetically, the toes looks best if the overall length pattern is parabolic.

The second toe (the toe next to the big toe) is the most common toe that will be excessively long. Frequently the second and third toes are unusually long and have areas of discoloration, hyper-pigmentation and/or contracture overlying the joints of the toe.

When a toe is excessively long the toe can contract or “buckle.” This contracture can be caused by the shape of the shoe. If a person with excessively long toes participates in active sports, the forward thrust of the foot in the athletic shoe can also cause contracture of the excessively long toe. The toe flexion or contracture can occur at either or both of the two toe joints.

If a toe is contracted or excessively long, there is no practical and permanent method of conservatively fixing the problem. Skin creams, taping, or toe braces are ineffective.

Fortunately, this type of problem can be easily and effectively treated by surgically shortening and straightening the toe. This specialized type of surgical procedure results in toes that are the appropriate length, straight, functional and free of discoloration or painful corns. In some instances excessively short toes can also be lengthened. It is important to carefully evaluate the length pattern of the toes such that the result will look natural. Toe flexibility must be maintained, particularly if the woman wishes to wear high-heeled shoes in the future.

Surgical Procedure

The most critical part of the procedure is determining the appropriate amount and location of bone shortening. Even a few millimeters of shortening can make a significant visual difference. The shortening is performed at either of the two joints within the toe using a specialized bone cutting instrument. Depending upon the amount of bone shortening, a portion of the skin then needs to be remodeled or removed. After the internal shortening has been completed, a plastic sutured skin closure is performed. The new toe length and alignment is immediately evaluated.

Toe Narrowing Procedure

When walking and applying pressure on the toes, particularly the great toe, there is commonly an increased width of skin and fatty tissue near the bottom of the toe. In some cases, this extra portion of skin can uncomfortably rub against the adjacent toe. The cosmetic surgical procedure can eliminate the portion of skin and underlying fatty tissue and make the toe have a more natural appearance.

Time Line and Home Recovery

The procedure can be done in the office under local anesthesia or can be done in an outpatient surgical setting (hospital or surgical facility.) After the surgery the patient is able to walk with full weight- bearing on both feet, without assistance. A special surgical shoe is provided. Approximately three days after the surgery, the patient is seen in the office for a dressing change. At two weeks after surgery, the patient is seen to remove the sutures. Suture removal is minimally uncomfortable.

During the first two weeks, in order to minimize swelling, decrease recovery time and produce the best results, ice packs should be applied and the feet should be elevated as much as possible. The results are usually permanent, functional and cosmetically very pleasing.

A moderate and gradually increasing amount of walking is allowing during the first two weeks after surgery. In many cases, it is possible to drive home after the surgery. Minimal pain medication is usually required. Tennis shoes can be worn two weeks after the surgery.

If you are traveling from outside of the Los Angeles area, see long distance travel.