What Is Hammertoe Surgery?
A hammertoe is a deformity that causes a toe to become bent upward
in the middle so it resembles a hammer. This can cause the toe to rub against the top of the shoe or irritate the end of the toe by jamming it into the ground. A hammertoe also can be associated with a contracture of the joint at the base of the toe and can often occur in conjunction with a bunion or other foot problems.
Non-surgical treatment for a hammertoe include padding the toe and changing or stretching shoes. If you still have pain, cannot participate in your normal activities, and/or cannot wear shoes comfortably, surgery may be an option. The main goal of hammertoe surgery is to correct the deformity, which will relieve the pain.
The hammertoe can be flexible or stiff. Depending on the flexibility of the toe and the preference of your foot and ankle orthopaedic surgeon, several different surgical procedures can be used to treat the hammertoe.
If you have active infections, poor circulation, or a serious illness (for example, heart disease), surgery may not be recommended. You should discuss your health history with your foot and ankle orthopaedic surgeon prior to considering hammertoe surgery.
Most often, hammertoe correction is done as an outpatient procedure, meaning you can go home the same day. You may be fully asleep during surgery or given an injection (nerve block) that makes the foot go numb temporarily. This is similar to what a dentist does to your tooth when filling a cavity.
If you have other toe problems in addition to the hammertoe, you should consider addressing the other deformities at the same time as one problem may contribute to the other.
The type of surgery depends to a large degree on whether the toe can be easily straightened during your examination.
Flexible Hammertoe: If your toe can be straightened, it is called a flexible hammertoe. A flexible hammertoe can be corrected with ligament and tendon lengthening or detachment procedures. One of the most common procedures involves transferring a tendon from the bottom of the toe to the top of the toe. This procedure stops the tendon from pulling the joint into a bent position and places the tendon in a position where it will help hold the toe down.
Fixed (Stiff) Hammertoe: If your toe cannot be straightened by the foot and ankle orthopaedic surgeon during the examination, it is called a fixed hammertoe. This means that the joint has become so contracted that releasing and lengthening the tendons and ligaments alone cannot restore the toe to a straight position. Some bone needs to be removed as well to get the toe to be straight. Usually, the end of the bone at the fixed (stiff) joint is removed to allow the toe to straighten completely.
Once the bone is removed, there are two options to stabilize the area:
- Pins can temporarily hold the toe in a straight position. This allows the area to fill in with scar tissue after the pins are removed.
- Fusing the joint is done by using pins, screws, or other implants to keep the toe straight. The goal is for the bone ends to heal together to become a solid bone rather than scar tissue.
For either option, as well as the flexible hammertoe treatment, your surgeon may need to release the joint and lengthen the tendon at the base of the toe to allow the toe to lay completely flat.
Usually, you are able to place your full weight on your foot after surgery without the need for crutches or a walker. You may also have a special shoe or boot to wear after surgery. You will need to lie down with your foot elevated at the level of your heart for the first few days
Stitches usually are removed 2-3 weeks after surgery. If pins
were placed, these will be taken out in the office a few weeks after the surgery. This usually is not painful because the pins loosen over time after the surgery and come out easily. You may not put your foot under water until the stitches and pins are removed.
Recovery usually takes several weeks depending on the type of surgery that was done. If the hammertoe is on your right foot, you may not be able to drive a car for several weeks.
Your foot and ankle orthopaedic surgeon may ask you to do exercises to stretch and move the toe at home after surgery. This can help with flexibility and motion.
It is normal
to have swelling after surgery. It may take many months for the swelling and symptoms to fully resolve.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications specific to hammertoe surgery include the chance that
the hammertoe may come back after your surgery. There is a risk that after the surgery you may feel like the toe is unstable. This is due to the cutting of bone, ligaments, and tendons. If you have a fusion there is a risk of the bones not healing. These complications are not common. Discuss the potential complications with your foot and ankle orthopaedic surgeon prior to undergoing hammertoe correction.
If I am treated with surgery will the hammertoe ever come back?
A hammertoe usually develops as a result of progressive muscle imbalance that deforms the toe. This progression does not necessarily stop at the time of surgery. It is therefore possible but unlikely that your hammertoe may come back after surgery. If this happens and you have discomfort in the toe, reevaluation and possible surgery may be an option.
Can I bend my toe after surgery?
Most hammertoe surgical procedures will result in some stiffening of your toe. Depending on the specific surgery performed, you may or may not be able to bend your toe once it has healed. The goals are to have a toe that is not painful and that you can place into a shoe easily. Your foot and ankle orthopaedic surgeon can discuss your surgery and possible outcomes in more detail.
Original article by Justin Kane, MD
Last reviewed by F. Ray Nickel, MD, 2020
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