Hammer toe surgery is a procedure to correct a deformity of the second, third, or fourth toe – the flexion of the middle joint that makes the finger look like a claw or hammer. Surgery is done to reduce pain and / or increase flexibility when the toe muscles cannot stretch and straighten.
Your healthcare provider may suggest toe surgery after more conservative measures have failed, such as wearing larger, more comfortable shoes or trying over-the-counter splints and pads.
What is hammer toe surgery?
This elective outpatient surgery is performed to straighten the toe joint when it becomes stuck in a flexed position and causes pain, irritation, or ulcers. In severe cases, the toe can be treated surgically in both adults and children.
Your surgeon may choose one or more surgical techniques, depending on your specific case and the level of deformity. Features include :
- Fusion : This is the most common surgical procedure for hammer toe, in which both ends of the bone are cut at the fixed joint. A Kirschner pin or wire is temporarily inserted to keep the finger straight; as soon as the ends melt, the pin is removed. A newer method involves the permanent implantation of a nail or screw .
- Tendon Shift – This involves redirecting the tendons from the bottom of the finger to the top to help it straighten.
- Joint resection : The end of the bone is removed from the fixed joint and pins are temporarily inserted to keep the finger straight.
Although the operation may involve more than one toe, you will most likely only be operating on one leg at a time .
If you have a flexible or lesser toe, your surgeon may suggest a less invasive procedure. This can include a tenotomy, which involves cutting the tendon instead of the bone to straighten the toe.
Your healthcare provider may also suggest an alternative to hammer surgery if you have a medical condition that increases the risk of the procedure, including infection, poor circulation, or an uncontrolled illness.
Complications common to toe surgery are minor, but can include:
- Repetition probability
- Feeling of "instability" in the area of the fingers due to the cutting of ligaments and tendons.
Before surgery, talk to your doctor about the possible risks associated with your case.
Purpose of hammer toe surgery
Hammer toe causes the toe to bend in the middle, which can irritate the end of the toe that is pressed against the ground and cause the raised part to rub against the shoe.
Toe surgery is usually done in severe cases to help straighten the toe and reduce associated pain.
Most of the time, this is due to wearing tight-fitting shoes or high heels that put pressure on the toes for a long period of time. This pressure can cause the toes to bend. Over time, the muscles in the toes become weak and cannot straighten.
Certain medical conditions can increase the chance of developing a toe. Rheumatoid arthritis can cause progressive damage to the joints in the foot, making them unstable and causing toe deformities.
Chronic nerve damage due to diabetes and muscle imbalance due to stroke or spinal cord injury can lead to poor foot mechanics, leading to hammer formation. If you have a concomitant medical condition, your healthcare provider may treat it first before considering toe surgery.
But before the surgery resolves, your healthcare provider will most likely ask you to try conservative treatments to make sure they provide adequate relief. These will focus on symptoms, help stretch or make your finger feel more comfortable, and may include:
- Wear shoes that have plenty of room around the toes (the toe should be about 1/2 inch longer than the longest toe).
- Exercises to stretch and strengthen the muscles of the toes
- Over-the-counter pads, cushions, or straps to soften or straighten your toes.
If this proves ineffective and you still have persistent pain or trouble wearing shoes, hammer toe surgery may be recommended to straighten the toe, depending on its flexibility or level of stiffness .
Before scheduling surgery, your surgeon will perform a physical exam and look to see if your toe is stiff or can be manually stretched. You may be asked for some X-rays to evaluate your bones and joints.
Lab tests may be ordered to make sure you are healthy enough for surgery, especially if you are at risk for chronic disease. This may include a blood test, such as a complete blood count (CBC) and an electrocardiogram (EKG) , to check the status of your heart .
You may also need permission from your PCP or a specialist, such as your cardiologist, before you can have surgery .
How to prepare
During your pre-operative meeting with the surgeon, you will have the opportunity to ask questions about the procedure. This may include what the surgical plan entails and what to expect after recovery.
Your surgeon may also suggest an appointment with a physical therapist before surgery. For several weeks after surgery, you will use assistive devices such as crutches or a walker to reduce the weight of your foot as you heal. A physical therapist will teach you how to use these devices before surgery.
They can also advise you on pre-procedure exercises that can improve your balance and strength in the opposite leg. This can make it easier to move around after surgery . A physical therapist may also recommend leg exercises after surgery to help you recover.
Your surgery will most likely take place in a hospital or surgical center. As part of your preparation, have someone drive you home after surgery.
What to wear
Wear loose, comfortable clothing to the hospital or surgery center. Before your procedure, you will be asked to change into a hospital gown.
Make sure you wear comfortable, non-slip shoes for a healthy foot after surgery. After the operation, you will not be able to wear normal shoes on the operated foot; A special boot will be provided for you .
Food and drink
If you are under general anesthesia, you will be advised to stop eating and drinking after midnight on the day of surgery to keep your stomach empty. Contact your surgeon for more advice.
Talk to your doctor or anesthetist about any medications you are taking before surgery. You may be asked to stop taking medications that can make bleeding worse, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and supplements such as fish oil and St. John's wort.
To avoid complications, tell your doctor about all prescription and over-the-counter medications you take, including medications, vitamins, supplements, and herbal medications.
On the day of your surgery, you should plan to bring all your documents, your insurance card, your driver's license, and the results of your preoperative exam if they were taken to a location other than your surgery.
If your healthcare provider offers you an assistive device, such as a walker or crutches, be sure to take it with you. If you don't already have them before surgery, you can get them at the hospital when you are ready to go home.
Lifestyle changes before surgery
To reduce the risk of complications, talk to your doctor about quitting smoking before surgery . Nicotine slows blood flow, increasing the likelihood of blood clots, healing problems, and infections after surgery.
You can also make some changes at home before surgery. For example, move your bed from the second floor to the first floor so you don't have to climb stairs during treatment.
You will need to schedule some time off after surgery. Depending on whether you have a sedentary or permanent job, this can take from one to six weeks. Talk to your surgeon about how long to avoid working.
You can also ask someone to help you with household chores, as well as taking care of your children or pets, while you recover. Since full recovery can take about six weeks, try to stay off your feet as much as possible.
What to Expect the Day of Surgery
On the day of your surgery, a nurse or physician assistant will meet with you. They will review all of your case records, perform a physical exam, and clean the incision area. Next, you will likely meet with a surgical team that includes a surgeon, surgical nurses, and a physician assistant.
During the operation
General anesthesia is given through a breathing mask or through an intravenous (IV) line in the arm. When you fall asleep, the anesthetist may insert a breathing tube into your windpipe to protect your lungs during surgery. Instead, if you get a nerve block, your surgeon will inject medicine to numb the area.
The steps of the procedure will vary depending on whether your hammer toe is flexible or fixed.
Surgery for this condition may involve moving the tendons from the bottom of the finger to the top to help straighten the joint. The surgeon makes incisions in both places. Then one of the two tendons is transferred and fixed at the bottom .
If you have a stiff toe, your surgeon can remove the stiff joint by making an incision in the top of the toe and removing the end of the bone at the joint. The connection is temporarily held straight with pins.
Another option is fusion. The surgeon cuts the ligaments and tendons, as well as the ends of the joint bone. Typically, a K-shaped wire is used to hold the bones together until the ends heal. In the new procedure, rods and screws that do not need to be removed are implanted into the toe to keep it stable .
Your surgeon will close the incisions with stitches, which will be removed about two weeks after surgery. Once the operation is completed, you will be bandaged.
Hammer toe surgery should last less than an hour.
After the operation
Toe surgery is an outpatient procedure, so you can usually go home the same day as your surgery.
Hospital and surgical center discharge policies may differ. In general, you can walk away if you can stand and walk safely with help, eat and drink without nausea, and urinate without problems .
Surgical shoes or boots will be provided for you to wear at home. For pain, your surgeon may recommend additional medications such as Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen) .
Recovery generally takes about six weeks for most people, depending on what triggered the surgery. If the procedure was done on the right leg, you may not be able to drive for several weeks after surgery.
You will have a bandage on your leg that will be changed in the surgeon's office two to four weeks after surgery. The stitches are usually removed two to three weeks after surgery. The pins can be removed after three to four weeks .
You may be given open-toed, hard-soled surgical shoes that you can wear for about four weeks after surgery. After this time, your healthcare professional may recommend that you wear wide, deep, and soft shoes for up to six weeks.
When you rest, try to keep your leg elevated at heart level with pillows underneath for the first few weeks after surgery. Depending on how well you walk, you may also need crutches or a walker.
Keep dressings clean and dry. After the stitches are removed, your healthcare provider will most likely give you another dressing for two to four weeks.
Follow your surgeon's instructions on when to start washing the area. While wearing the bandage, you should take a sponge bath or cover your foot with a plastic bag while bathing, making sure that no water gets inside.
Your surgeon may recommend that you exercise after surgery to improve the flexibility of your toe. Follow your surgeon or physical therapist's instructions on what exercises to do and how to avoid injury.
If you experience any discomfort, your healthcare provider may recommend that you continue taking over-the-counter pain relievers.
Call your doctor if pain, bleeding, or increased swelling, redness, or drainage around the wound persists.
Long term care
Since hammer toe can be caused by shoes that don't fit, be sure to wear comfortable shoes that have plenty of room in the front toe area.
Avoid wearing tight shoes or high heels. Ask your healthcare provider about exercises you can do to increase mobility and prevent relapse.
Possible future operations
Toe surgery is usually 80-90% successful. About 5% to 10% of patients may have mallet toe again, but these cases may not be in the same joint or toe. Less than 5% of people may have a fixation device that is loose or painful and needs to be repaired.
If surgery is needed again, you can repeat the same procedure, or your healthcare provider may choose a different surgery based on your condition. For example, if you had a tendon transplant, they may decide to have a fusion procedure the next time.
Get the word of drug information
Hammer toe surgery may be an option if you have pain or trouble walking. For many people, it can successfully treat a severe case in which other conservative treatments do not work. The condition may come back, so ask your doctor if you may need another surgery in the future. They can help you determine if toe surgery is the best treatment for you.
Frequently asked questions
The middle toe joint will rise rather than lie flat. There may also be visual swelling around the joint and toe, and a callus may form from excessive friction.
There are several helpful things you can do to prevent hammer toes, including wearing a proper shoe with arch support and a wide toe, removing calluses with a pumice stone, and doing exercises to stretch and strengthen your toes. This can include stretching and bending the toes or moving each one individually.
No, hammer toes require treatment, but that does not necessarily mean surgery. Conservative treatments, such as orthotics and shoe inserts, can help control symptoms.