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6 Common Questions About Hammer Toe Surgery

If you have a hammer toe, you may have many questions. In this article, Dr. Sachs discusses 6 common questions he hears from his patients.

1. Why did I develop a hammer toe?

A hammer toe is a contracture, or curling, of the joints in the toe. This curling is the result of an imbalance of the muscles and tendons in the toes. A hammer toe typically develops over time and can affect any toe of the foot.

There are several factors that can cause this deformity such as arthritis, high arch foot, injury to the toe, and wearing shoes that fit improperly. Shoe characteristics can increase the risk of developing hammer toes including high heels, narrow or pointed toe boxes and tight shoes. In addition, there are certain diseases including diabetes, arthritis, and a stroke that can affect the nerves and muscles of the foot resulting in a tightening of the tendons and a contracture of the toe.

2. Can you fix a hammer toe without surgery?

There are a variety of treatment options for hammer toes. In many cases, a hammer toe is a treatable condition. However, generally speaking, surgery is the only way to “fix” a hammer toe. In mild, earlier stages, hammer toes tend to be flexible deformities and the symptoms can be treated with nonsurgical options.

Treatment is focused on relieving the pain and pressure associated with the hammer toe.  Padding and taping the toe can relieve pressure from shoes and temporarily realign the toe. In addition, avoiding high heels and narrow shoes will help prevent irritation of the toe. Instead, wear shoes with a deeper toe-box that will provide more room for the toe.

Medications including nonsteroidal anti-inflammatory drugs and steroid injections may help relieve the pain and inflammation associated with hammer toes. Finally, custom orthotics and arch supports help control foot function and may help to prevent worsening of the hammer toe deformity.

3. Are there potential complications from hammer toe surgery?

In regards to hammer toe surgery, the goal is usually to provide pain relief and improve function of the toe. In addition, the surgeon also wants to improve the cosmetic appearance of the toe. Even though hammer toe surgery is considered relatively straightforward and generally successful, complications from surgery can still occur.

There are complications that can be associated with any surgery including persistent pain and swelling, scarring and infection. Complications that could arise from hammer toe surgery can include recurrent deformity, loss of correction, floating toe (misalignment with other toes), stiffness of the toe, poor bone healing, pain across the ball of the foot, and the need for revision surgery.

4. When is hammer toe surgery needed?

If the hammer toe is left untreated, the toe deformity will frequently progress and become more rigid with time. Surgical treatment is often recommended when conservative treatment fails to relieve symptoms. Surgery may also be necessary when the pain of the toe makes wearing shoes challenging or if there is difficulty performing daily activities.

5. How do you fix a hammer toe? Will I have a pin sticking out of my toe?

There are several different types of surgical procedures to correct a hammer toe. The procedure is typically based on the severity of the toe deformity. The surgery requires removal of a portion of bone at the contracted joint in order to realign the toe.

In general, there are two types of surgeries to correct hammertoes. First, a joint resection or arthroplasty is performed by removing a portion of bone at the contracted joint. Second, a fusion or arthrodesis is performed where the bones of the contracted joint are mended together. On occasion, soft tissue balancing procedures are used to realign the toe. 

The use of surgical hardware is commonly used in order to maintain correction of the toe. There are several different types of hardware used including metal pins or wires, absorbable pins, screws, metal and polymer implants, and cadaver bone. One of the most common types of hardware used for hammer toe surgery is a metal pin, also known as a k-wire. If used, the pin will be sticking out of the end of the toe for 2-6 weeks until the toe heals and the pin is removed.

6. What is the expected recovery time?

The recovery time following hammer toe surgery can vary depending on the procedure performed. In general, it takes approximately 6 weeks to 3 months to fully recover from surgery. Many patients can walk immediately following surgery in a stiff-soled, surgical shoe or boot. Patients can typically return to normal activities after 2-3 months.

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