Hammertoe Surgery

What is Hammertoe?

Hammertoe occurs when toes are curled as a result of a bend in the middle joint of the toe. It usually occurs at the second, third or fourth toes and is sometimes referred to as contracted toe or rotated toe. It usually happens as the tendons at the top and botom of the toes become imbalanced and pull the toe into the hammertoe position. When the toes are bent in this way, the result resembles a hammer shape, therefore giving the name hammertoe.  A variety of biomechanical issues in the feet can cause tendon imbalance.

People with hammertoe may have corns and calluses form on the top of the middle joint of the toe, or on the tip of the toe. There can be swelling and redness around the toes and stiffness can make it difficult to walk. Individuals with hammertoe may feel constant pain when on their feet. Oftentimes hammertoe surgery is required to relieve this pain.

Hammertoe can be flexible or rigid. Flexible hammertoe can be manually corrected and may respond to conservative treatment like foot orthotics to correct biomechanical insufficiencies.  Rigid deformity would require hammertoe surgery for correction.  However, accommodation of the deformity may be possible using appropriate footwear or foot orthotics.

Hammertoe Surgery: What is the Process?

There are several types of hammertoe surgeries used to correct this problem. Some surgeries may require general anaesthetic while others are completed safely under local anaesthetic. In most cases, hammertoe surgery can be done during the day and you will not have to stay overnight at the hospital. The foot and prepared and a small incision is made. Your surgeon will be using small tools to work in this delicate area of the foot.

Types of Hammertoe Surgery

 The most commom hammertoe surgery types are:

• Tendon transfer
• Arthrodesis
• Arthroplasty

Tendon transfer is a hammertoe surgery that involves re-routing the tendon from under your toe to the top of the toe to correct the position. This hammertoe surgery is often chosen if the toe is mobile. Otherwise, it can be used in combination with the following procedures.

Digital arthrodesis involves straightening the toe and fusing the joint completely. The surgeon inserts a wire into the toe that extends past the end of the toe to hold it in place for around 3-6 weeks.

Another type of hammertoe surgery is implant arthroplasty, or joint replacement. Here an implant made of silicon, rubber or metal is inserted in the toe to act as a replacement for the removed bone.

After having hammertoe surgery, you can expect to have some swelling, stiffness and limited mobility. For some it can take as long as 8-12 weeks to be walking normally again, but others can walk immediately after surgery. A typical recommendation could be to restrict activity for 24 hours after hammertoe surgery, wear a splint for 2-4 weeks, and wear appropriate footwear. Exercises to increase the strength in the toe muscles may also be suggested.

According to the surgeon, which surgery they performed and the way they did it, instructions after hammertoe surgery will differ...so follow the surgeon's instructions to the letter.

There are risks associated with any surgery, and hammertoe surgery is no different. Your toes may swell for long periods following hammertoe surgery, you may have nerve injury, numbness, or limited range of motion, pain may continue or infection may set in. There is also no guarantee that the procedure will work and the deformity may return.

There are more conservative approaches to relieving pain from hammertoe. Using splints to realign the affected toe may take away your need for hammertoe surgery. Protective padding on corns and calluses may take away your pain as well. It is very important to choose the correct footwear by selecting shoes that have a wide toe box and do not irritate the toe.

Wearing foot orthotics designed to relieve the pressure on your toe deformity and increase your foot efficiency can be effective. If the hammertoe deformity occurred because of improper positioning of your foot, orthotics can also be important to control position after your hammertoe surgery so the hammertoe deformity does not return.

Your physician will take several factors into consideration before suggesting hammertoe surgery. If your toe is very painful, your condition interferes with your daily activities, and more conservative treatments have not proven successful, hammertoe surgery may be necessary.  It will also be suggested more readily if you have a rigid rather than flexible deformity.

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