Forefoot Surgery

Forefoot surgery means operations on the front third of the foot, where the toes join the long metatarsal bones. The most common targets are crooked lesser toes, a stiff big toe joint and a nerve trapped between the toes. Most procedures take about 45 minutes and are done as day cases under a regional block.

What is forefoot surgery?

The forefoot carries much of your body weight when you push off to walk or run. It includes the five toes, the joints at their base and the metatarsal heads that form the ball of the foot. Small changes in shape here, such as a toe that curls or a joint that stops bending, can make every step uncomfortable.

Forefoot surgery is not a single operation. It is a family of procedures, each designed for one condition. Surgeons may combine two or three in one visit, for example correcting a hammertoe next to a bunion, which is described separately on our bunion surgery page.

Which problems does forefoot surgery treat?

Three conditions account for much of the work. A hammertoe is a lesser toe that bends at the middle joint and rubs on the shoe. Hallux rigidus is arthritis of the big toe joint that makes it stiff and sore, especially when you push off. A Morton's neuroma is a thickened nerve between the third and fourth toes that causes burning and a feeling like a pebble under the ball of the foot.

Details of each problem are on our pages for hammertoe, hallux rigidus, Morton's neuroma and bunions. Other forefoot problems, such as pain under the metatarsal heads, are treated with related operations.

How does forefoot surgery work?

The principle depends on the problem. For a hammertoe, the surgeon releases tight tendons or removes a small piece of bone so the toe lies straight, and may fix it with a thin pin or an implant. For hallux rigidus, the surgeon shaves off bone spurs or, in severe cases, joins the joint so it no longer moves. For a neuroma, the surgeon either relieves pressure on the nerve or removes the damaged section.

In every case the goal is the same: to give the foot a shape that fits a shoe and a joint or nerve that no longer hurts with each step. The operation changes mechanics, not just appearance.

Is forefoot surgery major surgery?

It is considered minor to intermediate surgery. The incisions are small, most patients go home the same day and there is no long hospital stay. Even so, it involves bone, tendon and nerve, and the foot must be protected while healing, so it deserves the same respect as larger operations.

People often underestimate swelling. The forefoot is the lowest part of the body, so blood and fluid collect there, and elevation is needed for the first 2 weeks. Planning your week around that advice improves comfort and the final result.

How is forefoot surgery different from bunion and flatfoot surgery?

Bunion surgery realigns the first metatarsal and is a bone-correction operation of its own. Flatfoot work, covered on our flatfoot reconstruction page, rebuilds the arch and heel and is a much larger undertaking. Forefoot surgery on a hammertoe, a stiff big toe joint or a neuroma is smaller, quicker and usually less restricting afterwards.

Some patients need several of these at once. A person with a bunion, a hammertoe and a neuroma may have a combined plan, with a longer anaesthetic and a recovery closer to that of bunion surgery.

Who should think twice before having forefoot surgery?

People with poor blood supply to the feet, nerve damage from diabetes, an active infection or ulcer, or very tight smoking habits should talk through the risks, because wounds in the toes can heal poorly. Those whose pain comes from the back, a different nerve or a joint disease elsewhere may not benefit.

Surgery is usually a second step after good shoes, padding and exercises. A sudden break in a toe or metatarsal needs urgent local care first; treatment abroad is only for stable patients with planned procedures. See our forefoot surgery in turkey page, and our foot and ankle hub for related topics.

Preparation for forefoot surgery is simple compared with larger operations, but it still matters. It includes confirming the diagnosis with imaging, arranging medical clearance, stopping nicotine, planning a week of rest with the foot raised and choosing a roomy shoe for the other foot. Good planning shortens recovery and reduces wound trouble.

Which tests and scans are needed before forefoot surgery?

Weight-bearing X-rays of the foot show the toe angles, the length of the metatarsals and any joint wear. Ultrasound or MRI can confirm a Morton's neuroma and rule out other causes such as a stress fracture or joint inflammation. Nerve tests are rarely needed but may be used when the diagnosis is unclear.

Blood tests, an ECG for older adults and a review of medicines complete the pre-operative check. People with diabetes should have a recent blood sugar result, and those with poor pulses may need a circulation test.

How do I prepare my health?

Stop smoking and nicotine products at least 4 to 6 weeks before and until the bone has healed. Keep blood sugar steady, treat any skin infection or fungal nail infection and follow instructions about blood thinners or anti-inflammatory tablets. Do not stop prescribed medicines unless your doctor says so.

Maintaining a healthy weight reduces pressure on the forefoot during healing. Wear comfortable shoes in the weeks before surgery and avoid new blisters or cuts on the toes, which could delay the date.

What should I arrange at home and at work?

Plan to spend the first 3 to 5 days with the foot above the level of your heart as much as possible. Set up a chair and a footstool near a table, a bathroom within easy reach and a stack of meals that need little preparation. A walking stick or a single crutch helps if the surgical shoe feels unstable.

Desk workers usually return after 1 to 2 weeks, with a stool beneath the desk. Jobs on your feet may need 4 to 6 weeks. Ask for a work note in advance, and see our surgery day guide for a practical checklist.

What should I send for a remote review?

Send recent X-rays, any ultrasound or MRI reports, notes about footwear and treatments tried, medicines and allergies and photographs of the toes from above and from the side while standing. A clinician can then recommend a plan and say whether the operation can be done as a day case.

The quote request form collects these details, and our treatment planning guide shows how a plan is made. International patients usually have a video call before travel.

What do I pack and what happens before the operation?

Pack a loose shoe or sandal for the other foot, wide trousers, your medicines and scan files. You will normally stop eating about 6 to 8 hours before sedation. Shower with antiseptic soap if instructed, remove nail polish from the operated foot and arrange a companion to take you home.

Forefoot surgery is usually done under a regional block with sedation and takes about 45 minutes, although a combined procedure may take 90 minutes. The steps vary by condition: a hammertoe is straightened with a joint resection or fusion, hallux rigidus is treated with a cheilectomy or fusion, and a Morton's neuroma is released or removed.

How is anaesthesia given and how is the foot prepared?

The most common method is an ankle block, in which local anaesthetic is injected around the nerves at the ankle so the whole forefoot goes numb. You also receive light sedation and stay comfortable and relaxed. A small tourniquet around the ankle or calf provides a bloodless field and is released at the end.

You lie on your back with the leg slightly raised. The skin is cleaned, antibiotics are given when needed and sterile drapes cover the area. The surgeon marks the incisions on the foot before starting.

How is hammertoe surgery done?

Hammertoe surgery depends on whether the toe is flexible. In a flexible toe, the surgeon releases the tight flexor tendon at the base of the toe or moves it to the top of the toe, which pulls the toe straight. In a rigid toe, a small piece of bone at the middle joint is removed so that the two ends can lie flat.

1. Make a small cut over the bent joint on the top of the toe.
2. Release the tight extensor tendon and joint capsule so the bones can move.
3. Remove the end of the proximal phalanx, the bone nearest the foot, to shorten the toe slightly.
4. Hold the toe straight with a temporary wire pin that passes along the toe, or with a small implant that stays inside the bone.
5. Check the position, close the skin and apply a dressing and a spacer between the toes.

How is hallux rigidus surgery done?

The choice depends on how much cartilage is left. For early disease, a cheilectomy shaves off the bone spurs on top of the joint so the toe can bend upward again. A Moberg osteotomy, a small wedge cut in the base of the toe bone, may be added to tilt the toe and improve the push-off position.

For advanced disease, the surgeon fuses the joint. The damaged surfaces are removed, the toe is placed in a comfortable angle and the bones are fixed with screws or a small plate until they join. In selected patients, a cartilage implant or a spacer is used to keep some motion, although long-term data are more limited than for fusion.

How is Morton's neuroma surgery done?

The nerve is reached through a short cut on the top of the foot between the metatarsal heads or occasionally from the sole. In a decompression, the surgeon cuts the ligament that presses on the nerve so it has room. In a neurectomy, the thickened section of nerve is removed, which leaves a small numb patch between the toes.

Neurectomy gives reliable relief for most patients but can leave the toes numb. A decompression avoids numbness but may be less predictable if the nerve is already severely thickened. Your surgeon will explain which they prefer and why.

Which forefoot surgery techniques are compared?

How long does forefoot surgery take?

Forefoot surgery usually takes about 45 minutes for a single procedure. A neuroma removal or one hammertoe correction may take 20 to 30 minutes, whereas a big toe fusion with other toe corrections may take about 90 minutes. You also spend an hour or so in recovery before going home.

How is the wound closed and protected?

Skin is closed with fine nylon stitches that are removed after about 2 weeks. A soft bandage with a toe spacer holds the toes in position, and you are given a surgical shoe with a stiff sole. Heavy casts are rarely needed, except after some fusions in which a short walking boot is used.

Forefoot surgery is normally a day case, with 0 hospital nights. You arrive in the morning, have the operation and go home a few hours later once the numbness has begun to wear off and you can walk safely in your surgical shoe. Some people with complex or combined procedures stay a night.

What happens on the day of surgery?

You check in, meet the surgeon and anaesthetist, and have the operative foot marked. After about 45 minutes in theatre you wake in recovery with a bulky dressing and a numb foot. You are offered a drink and a snack, and a nurse checks your toes for warmth and colour.

A physiotherapist or nurse shows you how to walk in the protective shoe, keeping weight on the heel and outside edge. You are given painkillers, wound care instructions and a contact number before you leave.

How is pain controlled?

The block can numb the foot for 12 to 24 hours or more, so pain tablets should begin before the numbness fades. Regular paracetamol, with an anti-inflammatory if it is safe for you, covers most people. Ice around the bandage and keeping the foot high are powerful additions.

Throbbing at night in the first 2 or 3 days is common and improves with elevation. Call the team if pain climbs despite tablets, the bandage feels very tight or the toes turn pale, blue or cold.

How do you get moving?

Most people walk the same day with a protective shoe, short distances only. Keep steps small and frequent, and avoid long periods of standing in the first week. After a big toe fusion or a Weil osteotomy, you may be advised to walk on the heel and use a stick.

When can you go home?

You can leave when you are awake, comfortable on tablets, able to walk safely, can pass urine and have a responsible adult with you. The team gives written advice on elevation, bandage care and when to call. Anyone staying overnight leaves the next morning after a dressing check.

What does wound and bandage care involve?

Keep the dressing clean, dry and intact until the first review, normally at about 10 to 14 days. Cover the foot with a plastic bag when showering. Do not remove the pin in a hammertoe yourself. After the stitches are removed, you start gentle toe movement and scar massage.

What should international patients know?

Because this is a day-case procedure, you could technically fly soon, but the surgeon will want to check the wound and remove any pin or stitches before you go. Most international patients stay 5 to 7 days, and those with a toe fusion or a combined plan may stay a little longer.

Plan an aisle seat, elevation during the flight and a companion to help with bags. Our travel and accommodation guide, flying after surgery guide and companion guide cover the details, and the hospital directory lists accredited centres.

Most people heal from forefoot surgery over about 6 weeks. You walk in a protective shoe from the first day, return to desk work in 1 to 2 weeks and wear a normal roomy shoe at about 6 weeks. Swelling, stiffness and tenderness may continue for 3 to 6 months, and big toe fusions take a little longer.

What is the forefoot surgery recovery time?

The forefoot surgery recovery time depends on the operation. A neuroma removal or simple hammertoe correction usually allows normal shoes at about 4 to 6 weeks. A big toe fusion needs about 6 to 8 weeks in a stiff shoe or boot, and returning to sport takes 3 to 4 months. Full comfort often arrives by 6 months.

Bone heals in roughly 6 to 8 weeks, whereas soft tissues need longer. This is why swelling and a feeling of tightness in the toes persist after the stitches are out.

What is normal pain and swelling?

Expect throbbing and tightness for the first week, with the toes looking puffy and bruised, sometimes with purple colour reaching the arch. Elevation above the heart for most of the day in the first 3 to 5 days is the best treatment. Swelling returns at the end of the day for months.

A pin-fixed hammertoe often looks stiff and red at the tip for a few weeks. This improves as the pin is removed and the toe is moved. Increasing redness spreading up the foot, fever or discharge is not normal and needs a call to the surgeon.

What happens at 2, 6 and 12 weeks?

At about 2 weeks the stitches are removed, the pin is checked or removed and you begin to move the toes. By about 6 weeks X-rays show whether a fusion or osteotomy is healing, and you move to a wide, supportive shoe. By 12 weeks most people are back to normal walking, light sport and most shoes, though some swelling lingers.

What physiotherapy and exercises help?

Therapy is light but valuable. After the first review, you begin gentle toe stretches, towel scrunches, marble pick-ups and ankle circles. Scar massage and desensitising rubs reduce tenderness. For hallux rigidus surgery that preserves movement, early movement of the big toe is especially important to keep the new range.

Calf stretching and balance work help you walk normally again, since many people unconsciously limp on the outside of the foot. Our rehabilitation guide explains how to organise a home programme.

When can I drive, work, fly and exercise?

Driving after right-foot surgery usually waits until you can wear a normal shoe and brake firmly, often 2 to 4 weeks for a soft-tissue operation and 6 weeks after a fusion. Desk work often resumes after 1 to 2 weeks. Physical work needs 4 to 8 weeks.

Flying is usually fine after the first check, with elevation and movement during the flight. Swimming starts once the wound is healed, cycling at 4 to 6 weeks and running at about 3 months, guided by your surgeon.

Which symptoms need urgent attention?

Contact the team for fever, spreading redness, discharge, a bad smell, severe pain, toes that turn white, blue or cold, calf pain or swelling, chest pain or breathlessness. After returning home, our follow-up after returning home guide explains how to arrange reviews and X-rays locally.

Most people who have forefoot surgery report less pain and an easier time with shoes, and a large majority of well-selected patients are satisfied. Success means a comfortable forefoot that fits ordinary shoes, not a toe that looks or moves like a never-injured one. Results differ by condition, which is why each is discussed separately below.

What does a good result look like for each condition?

After hammertoe surgery, a good result is a toe that lies straight or nearly straight, no longer rubs on the shoe and has lost its corn. It may be a little shorter and stiffer at the middle joint, and the tip may not touch the ground, which is normal. Most people accept this trade for pain relief.

After hallux rigidus surgery, success is less pain on pushing off. A cheilectomy usually restores some upward bend, while a fusion removes motion at the joint but allows a strong push-off and long walks. After neuroma surgery, burning and tingling often ease or disappear, with a small numb patch between the toes in many people.

What is the forefoot surgery success rate?

Studies suggest that most patients have meaningful pain relief after each of these operations, with hammertoe correction and big toe fusion among the most reliable. Neuroma surgery helps many people but a minority keep some symptoms. Because success is defined differently in each study, no single percentage describes forefoot surgery.

Ask your surgeon for their own outcomes for your condition. A candid conversation about the chance of residual pain, recurrence or numbness is a good sign.

What factors improve or worsen results?

How long do the results last?

Many corrections last for years. A fused big toe or a fused hammertoe is very durable. Soft-tissue corrections can drift if tight shoes return, and a cheilectomy may need conversion to a fusion if arthritis progresses. A removed neuroma rarely grows back in the same form, but a stump neuroma can develop in a few people.

When is revision needed?

Revision may be considered when a toe remains crooked or floats, a joint fails to fuse, hardware is painful or a neuroma pain persists. It is more complex than a first operation, and a detailed assessment of why the first operation failed is essential. If you have had earlier surgery, send operation notes and X-rays with your enquiry.

Forefoot surgery uses small implants, wires, screws and plates together with live X-ray imaging. Many hammertoe and neuroma procedures need only sutures and a temporary pin, while fusions and osteotomies use screws or plates. Arthroscopy, ultrasound guidance and 3D-printed implants appear in some units but are optional.

Which implants and fixation devices are used?

A Kirschner wire, often called a K-wire, is a thin steel pin that holds a hammertoe straight for about 3 to 6 weeks and is then pulled out in clinic. Intramedullary implants, small peg-like devices inside the bone, give internal hold without a pin sticking from the toe. These may be metal, polymer or absorbable.

For a big toe fusion, compression screws and a low-profile plate give a firm hold, and a precise preparation of the joint surfaces matters as much as the hardware. Weil osteotomies are fixed with a single small screw.

What implants exist for the big toe joint?

Besides fusion, some surgeons use a synthetic cartilage cap, a metal or ceramic hemi-implant or a soft-tissue interposition graft to keep movement. Evidence for these options is shorter than for fusion, and surgeons differ in their enthusiasm. Ask about the track record of the specific device and what happens if it fails.

How does imaging guide the operation?

A mobile X-ray unit, called a C-arm, confirms the toe position, pin placement and the length of the shortened bone before the wound is closed. Ultrasound before surgery can mark the neuroma precisely, and some surgeons use it to guide injections. Weight-bearing CT is used in a few specialist centres for complex deformities.

Are there minimally invasive and navigated options?

Some centres perform hammertoe and metatarsal procedures through very small cuts with specialised burrs under X-ray control. Benefits include smaller scars and perhaps less swelling, though not all patients are suitable and the learning curve is real. Robotics and computer navigation are not part of routine forefoot care.

Which dressings and shoes support healing?

Toe spacers, silicone sleeves and soft bandages protect the correction, while a stiff-soled surgical shoe offloads the forefoot. After healing, shoes with a wide toe box, a soft upper and a firm sole keep pressure away from the toes. Custom insoles with a pad behind the metatarsal heads help neuroma and metatarsalgia patients.