Hammertoes are painful deformities that frequently form on the second, third, or fourth toe. The condition is often caused by an issue in foot mechanics. This can be caused by the person’s specific gait or the manner in which they walk, or by shoes that do not comfortably fit the deformity. Hammertoes can be formed after wearing shoes that are too narrow or short for the foot or have excessively high heels. Shoes that are not properly sized will force the toes into a bent position for long periods of time. This can cause the muscles to shorten and toes to bend into the deformity of a hammertoe.
Hammertoe correction is one of the most common procedures performed by our foot surgery team, ranging from simple in-office adjustments for flexible toes to surgical realignment for toes that have become rigid.
Hammertoe can also be caused by complications from rheumatoid arthritis, osteoarthritis, trauma to the foot, heredity, or a cerebral vascular accident. Pain and difficult mobility of the toes, deformities, calluses, and corns are all symptoms of a hammertoe.
Someone who suspects they have the symptoms of a hammertoe should consult with a physician—particularly a podiatrist. Podiatrists diagnose and treat complications of the foot and ankle. If the podiatrist discovers that the affected toes are still flexible, treatment for the hammertoe may simply involve exercise, physical therapy, and better-fitting shoes. Treatment for hammertoes typically involves controlling foot mechanics, such as walking, through the use of customized orthotics.
Hammertoe Surgery: What to Expect
When a hammertoe has become rigid, or when conservative treatments like orthotics, padding, and shoe changes no longer provide relief, surgical correction is often the most effective way to permanently straighten the toe and relieve pain. Choice Podiatry Center offers several surgical approaches, and the right one depends on how flexible or rigid the toe has become and whether other toe deformities are present.
- Tendon release or lengthening. For toes that are still somewhat flexible, a podiatrist may release or lengthen the tight tendon that is pulling the toe into its bent position, allowing the toe to straighten.
- Joint resection (arthroplasty). A small piece of bone is removed from the affected joint to relieve pressure and allow the toe to lie flat. This is one of the more common approaches for moderate hammertoes.
- Joint fusion (arthrodesis). For more rigid or severe deformities, the joint may be fused in a straightened position using a small pin, screw, or implant, permanently correcting the bend.
For more serious cases in which the toes have become inflexible and rigid, surgery may be suggested. During the operation, the toe typically receives a small incision to relieve pressure on the tendons, and a re-alignment of the tendons or joint may then be performed, sometimes by removing small pieces of bone to straighten the toe. In some cases, the insertion of a temporary pin is needed to keep the bones in the proper position as the toe heals. The patient is usually allowed to return home on the same day as the surgery.
Most hammertoe surgery is performed on an outpatient basis under local anesthesia, meaning you go home the same day. Depending on the procedure, a temporary pin may be used to hold the toe in position while it heals, and this is typically removed in the office a few weeks later.
Recovery After Hammertoe Surgery
Recovery time varies depending on the specific procedure and whether other toes or the forefoot were treated at the same time, but most patients can expect some combination of the following:
- Wearing a stiff-soled surgical shoe or boot for several weeks to protect the toe while it heals
- Keeping the foot elevated and reducing activity during the first one to two weeks to control swelling
- A gradual return to regular, roomy shoes over four to six weeks as swelling subsides
- Follow-up visits to monitor healing, remove any temporary pin, and check alignment
- Physical therapy or home stretching exercises in some cases, to restore flexibility and strength once the toe has healed
Swelling can take several months to fully resolve, which is normal, and most patients are back in athletic or supportive shoes well before all residual swelling has gone down.
If surgery is performed to repair a hammertoe, following the postoperative directions of your doctor is essential. Directions may include several stretches, picking up marbles with your toes, or attempting to crumple a towel placed flat against your feet. Wear shoes that have low heels and a wide amount of toe space to maintain comfort. Closed-toe shoes and high heels should be avoided. Shoes with laces allow the wearer to adjust how fitted he or she may want the shoes to be and also allow for greater comfort. To provide adequate space for your toes, select shoes that have a minimum of one-half inch of space between the tip of your longest toe and the inside of the shoe. This will also relieve pressure on your toes and prevent future hammertoes from forming.
Other preventative measures that can be taken include going shopping for new shoes in the middle of the day. Your feet are its smallest in the morning and swell as the day progresses. Trying on and purchasing new shoes midday will give you the most reliable size. Be sure to check that the shoes you purchase are both the same size. If possible, ask the store to stretch out the shoes at its painful points to allow for optimum comfort.