Hammertoe surgery

Hammertoe surgery is performed to correct certain deformities of the foot. During the surgery the position of the toe bones is adjusted.

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What is a hammertoe?

Hammertoe (digitus malleus) is a foot deformity characterised by an abnormal bend in the middle joint of a toe, making it resemble the shape of a hammer. It usually affects the second, third and fourth toes.

How do hammertoes form?

Hammertoe is caused by an inadequate balance of the foot’s structure, namely a collapse of the transverse arch. If the balance of the foot is disrupted, the toes are forced to bear more weight than they were designed to withstand. and as a consequence they bend. Remaining in this position for an extended period of time causes the toe muscles to shorten, resulting in a deformity called hammertoe. Hammertoes are often accompanied by bunions, as the presence of a bunion can put pressure on the big toe which in turn presses on the second toe, and so on.

What are the symptoms?

The most typical symptom of hammertoe is an abnormal bend in the 2^nd, 3^rd or 4^th toe towards the middle. On the surface of the deformed toe corns and calluses might appear, accompanied by redness, inflammation, and pain. If left untreated a decrease in range of motion and stiffness may occur in the affected joint.

How is a hammertoe treated?

The aim of any kind of hammertoe treatment is to restore the balance of the foot and to slow the progression of the deformities already present. Once a deformity has appeared, it cannot be reversed, the anatomical structure of the foot can only be restored surgically. Conservative treatment can only be effective in the early stages.

As a first line of treatment, make sure to wear the right shoes. It can ease the pain, relieve pressure and prevent the progression of the deformity. If possible, wear low-heeled (no more than 2-3cm) shoes with a spacious toe box, made of flexible material, with soft insoles. Avoid shoes with pointed toes.

Exercises to stretch and strengthen your toe, such as scrunching up a towel with your toes, may help in some cases. Pain and inflammation can be reduced with OTC anti-inflammatory drugs.

In more severe or longstanding cases hammertoe surgery is often necessary to correct the deformity.

When is bunionectomy and/or hammertoe surgery recommended?

Hammertoe surgery is recommended if conservative therapy was ineffective, the complaints have a significant impact on the patient’s quality of life, and the deformity cannot be corrected in any other way.

What happens during hammertoe surgery?

During your first appointment your orthopedic specialist will provide you with detailed information regarding the preoperative tests you need to undergo, the surgery itself (techniques, potential risks and recovery), and aftercare.

This type of surgery is performed under local or regional anesthesia.

The aim of the surgery is to reposition the toe, realign tendons, and remove deformed or injured bone. During the surgery, the surgeon may partially or totally remove the joint under the crooked part of the toe, reroute the tendons shorten the toe and insert surgical hardware if necessary. He or she may smoothens the sharp edges of the bone before stitching up the wound.

Are there any risks associated with the operation?

Similarly to other surgical interventions, hammertoe surgery also carries a certain risk of complications. On rare occasions the surgical site may become infected and the resulting inflammation can spread to the surrounding tissue, potentially affecting tendons, muscles, blood vessels, nerves and bones. In most cases pharmaceutical treatment is sufficient to control the infection, but in severe cases further operation may become necessary.

What to expect after surgery?

The day after the operation your bandage will be changed and you can leave the hospital. Stitches removal will take place 7 to 10 days later.

After hammertoe surgery, avoid intense physical activites involving the foot during the first week, however, there is no need for constant bed rest. On average, complete recovery takes about 3-4 weeks. After this period you can return to your normal activities.

What happens if the condition is not treated?

Without treatment, foot deformities tend to get worse: an untreated hammertoe can become stiff and painful.

Early treatment of the deformities is strongly recommended because bearing weight on your forefoot can damage the metatarsophalangeal joint and the small joints. Inadequate balance of the foot structure affects the ankle, the knees and the hip joint, and can even cause backpain.