Hammertoes

Hammer toe surgery is an outpatient procedure performed to treat an abnormal curve or bend in the middle joint of the toe. This deformity often makes moving the affected toe painful and difficult. Oftentimes, the affected toe will rub against the inside of a patient’s shoe, resulting in corns and calluses, causing additional discomfort. If conservative treatments such asorthotics and toe strengthening exercises fail to ease the associated discomfort, hammer toe surgery is often a remedy.

To complete the surgery, an orthopedic surgeon will make small surgical cuts on the affected toe and use surgical instruments to go inside the toe and repair it. Although there are various types of surgeries that can be done to correct hammer toes, operations typically involve cutting, straightening or removing part of the toe’s tendons, bones, and/or joints to realign the connective tissue to the foot bones. Additional incisions may be made to prevent the toe from bending downward. Surgical hardware such as pins or wire may be put in the toe to aid the healing process. Small sutures will then be used to close the surgical incision, and are typically removed seven to ten days after surgery.

CAUSES OF HAMMER TOE

It is possible to be born with a hammer toe, however many people develop the deformity later in life. Common causes include:

  • Tightened tendons that cause the toe to curl downward
  • Nerve injuries or problems with the spinal cord
  • Stubbing, jamming or breaking a toe
  • Having a stroke
  • Being a diabetic
  • Having a second toe that is longer than the big toe
  • Wearing high heels or tight shoes that crowd the toes and don’t allow them to lie flat
  • Aging

WHO NEEDS HAMMER TOE SURGERY?

Many people first realize they have an advanced hammer toe after conservative treatments such as orthotics and toe strengthening exercises fail to relieve their pain. Patients with an advanced hammer toe may experience stiffness or cramping in their toe, pain in the middle joint or base of their toe, or they may have toe and/or foot pain that affects their ability to walk properly.

To determine if hammer toe surgery is the proper course of treatment, your orthopedic doctor will ask about your symptoms and medical history. A physical examination of the toe will be performed and x-rays may be taken. Hammer toe surgery may be recommended for patients with an advanced hammer toe to delay the progression of the deformity and diminish discomfort.

TYPES OF HAMMER TOE SURGERY

There are several surgical methods to correct a hammer toe. Your physician will decide which method will be most beneficial to you depending on the severity of your deformity, the direction the toe is deviating and the length of the affected toe. Some common surgical methods include:

  • Arthroplasty– To promote straightening, half of the joint located directly underneath the crooked part of the toe is removed.
  • Arthrodesis (fusion) – To promote straightening, the joint directly underneath where the toe is crooked is completely removed. A wire or pin is inserted to aid healing.
  • Tendon transfer– Performed alone or in combination with other procedures, a surgeon will take tendons from under the toe and “re-route” them to the top of the toe to promote straightening.
  • Basal phalangectomy– Performed to assist patients with severe stiffness, this procedure removes the base of the bone underneath the toe.
  • Weil osteotomy– Performed to assist patients with severe stiffness, this procedure involves shortening the metatarsal bone and inserting surgical hardware to aid healing.

PREPARING FOR SURGERY

Although pre-surgery instructions may vary from patient to patient, your orthopedic doctor will likely request that you arrive at the surgical center or outpatient facility one or two hours prior to your operation. After you fill out your paperwork and get admitted to the facility, you will be evaluated by an anesthesiologist. Most hammer toe operations are performed under ankle block, local or regional anesthesia which means your foot will be numb but you will remain awake during the procedure. Some patients, however, may receive general anesthesia and will sleep through the operation. Depending on what type of anesthesia you will receive, you may or may not be able to eat, drink or take certain medications prior to surgery. You may also receive a sedative before the procedure to help you relax. Since the effects of sedatives can take a while to wear off, it’s important to arrange for someone to drive you home after your operation. Your doctor will give you specific instructions prior to your hammer toe surgery so you can prepare properly.

POST-OPERATIVE CARE

Following hammer toe surgery you will be moved to a recovery room. Most patients will be sent home after resting for a few hours. When you are discharged, your foot will be bandaged and you will be given a protective surgical shoe to help you walk after surgery. Stiffness, swelling, redness and discomfort are common for several weeks following surgery. Pain, however, is easily managed with prescribed medications. If you experience persistent burning sensations, numbness, or tingling in your foot or ankle that is not remedied by icing or elevation, call your doctor.

Full recovery typically takes one to three months, and largely depends on which toe was operated on and how well you follow your surgeon’s post-operative instructions. Although specific instructions will vary from patient to patient and will often be specific to the type of surgery performed, there are a number of general precautions your orthopedic physician will likely suggest to ensure proper healing. These include:

  • Keep your foot elevated as much as possible for the first few days after surgery and apply ice to relieve swelling and pain. Put the ice on for 20 minutes and then take it off for 40 minutes. Repeat as necessary, or per your physician’s instructions.
  • Avoid walking for long periods, especially during the first month of recovery.
  • If you smoke try to quit or cut back. Smoking can slow healing. Ask a health care professional for assistance.

POST-OPERATIVE LIMITATIONS

Following hammer toe surgery, certain activities may be unsafe or difficult to execute. Such activities may include:

  • Walking– Many patients are able to walk with the aid of crutches a few days following their surgery. However, mobility will remain somewhat limited for the first two weeks.
  • Wearing regular shoes– After two to eight weeks, most patients are able to discontinue use of their postoperative boots and start wearing wide, comfortable footwear. Patients who had hardware implanted during surgery will need to wait until the hardware is removed before wearing their own footwear.
  • Driving– Patients should not drive until they feel comfortable performing an emergency stop. This is typically four to eight weeks following surgery. Patients should notify their insurance company that they underwent hammer toe surgery to ensure that their auto coverage is still valid.
  • Returning to work– If you are able to get a ride to work and your job does not require much physical activity, you can return to work a week or two after surgery. Ideally, you should only return to work if you are able to keep your foot elevated while you are there. For those with more active jobs, it may be a month or two before your physician clears you to return to work.
  • Returning to sports and exercise– Although the full healing process typically lasts a year, many patients can return to physical activity after two or three months.

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