Hammer Toe Surgery

• Anti-inflammatory Medicines: Prescription strength medicines to decrease pain and inflammation.
• Physical Therapy: To strengthen poorly functioning muscles and stretch tight muscles that may be exacerbating the toes. Special ultrasound techniques may reduce inflammation.
• Custom Foot Orthotics: Dr. Delvadia, DPM creates an orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort and prevent future progression.
• Toe Splints or Pads: Specific pads may prevent pressure and physical irritation in shoes.  Toe splints and toe spacers physically realign the toes and can lessen pain and halt or stall hammer toe progression.
• Injections: Cortisone injections are strong anti-inflammatory agents to decrease pain, and swelling directly at the toe region.  Injections only treat the symptoms, and in some cases used in caution (and sparingly), they can weaken supporting ligaments of the toe(s).

Hammer Toe Surgery (Toe Shortening, or Toe Augmentation)

Toes can be surgically realigned and made straight again.  They can even be made shorter.  The good news is that toes can be corrected.  Hammertoe surgery is often synonymous with “toe shortening”, “toe job” and/or “toe augmentation”.  Depending on the severity and length of the toe, there are several methods to surgically correct a hammertoe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.

How Are Hammer Toes Surgically Corrected?

The basis for hammer toe surgery most often involves removing a portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe has deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.

There are generally two methods surgeons use to correct hammer toes – they are joint resection (arthroplasty) or bone mending (fusion), and the location where this is performed on the toe depends on where the toe is buckled. It’s important to recognize that most of the surgical work involved the joints of the toe, not the joint of the ball of the foot. Sometimes a toe relocation procedure is needed when the joint of the ball of the foot is malaligned (subluxed or dislocated).

1. Joint resection procedures involve removing part of one of the two small joints of the toe directly underneath where the digit is crooked. The purpose is to make room for the toe to be re-positioned flat or straight. Because hammer toes become rigid or fixed with time, removing the joint becomes the only option when the knuckle is stiff. It’s important to understand that this procedure does not involve the joint of the ball of the foot, rather the small joint of the toe. Medical terminology for this procedure is called a proximal interphalangeal joint arthroplasty or a distal interphalangeal joint arthroplasty, with the latter involving the joint closer to the tip of the toe.

    

2. Bone-mending procedures realign the contracted toe by removing the entire deviated small joints of the toe (again, not at the ball of the foot). This allows for the buckled joint to be positioned flat and the bone ends to mend together. Often surgical hardware (fixation) is necessary to keep the bones steady during healing. Hardware options can involve a buried implant inside the toe or a temporary wire that is removed at a later date. Medical terminology for this procedure is called a proximal interphalangeal joint arthrodesis (fusion), or a distal interphalangeal joint arthrodesis (fusion), with the former being performed in a high majority of cases.
3. Toe Relocation procedures are ancillary procedures that are performed in conjunction with one of the two methods listed about (joint resection or joint mending). When the toe is deformed (buckled) at the ball of the foot, then this joint often needs to be re-positioned along with ligament releases/repair to get the toe straight. A temporary surgical rod is needed to hold the toe aligned while the ligaments mend.

Hammer Toe Surgery Recovery

Recovery after hammertoe surgery generally depends on the method of surgery performed. In all cases, healing takes about 6 weeks in healthy people and there is no way to speed up that process. Patients often return to normal activities and shoe gear by 2 weeks to 3 months depending on just how severe the toe deformity was preoperative. Simple toe surgery can recover very quickly, and return to a shoo-in two weeks – especially with the 5th toe (the 2nd toe is trickier as people push-off of this toe). Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

Walking After Hammer Toe Surgery

Walking after hammertoe surgery is strongly dependent on the method (procedure) surgeons choose to correct the toe and the techniques used to stabilize the digit while mending. Also, the ability to mobilize quicker depends on which toe was operated on. In general, the 4th and 5th toe allow for a quicker return to shoes, as these toes are not needed for propulsion. The 2nd toe, however, is the most commonly deformed toe and tends to have more severe problems, requiring more surgical work.

Nearly all of Dr. Delvadia, DPM’s patients are walking immediately after hammertoe surgery in a stiff-soled surgical shoe. Sometimes, patients may have the bunion repaired at the same surgical setting, and that may dictate whether or not walking would be allowed.