What is hammertoe correction?
Hammertoe correction, or hammertoe surgery, is a procedure that treats hammertoe—a deformity of the second, third or fourth toe that leaves it bent at the middle joint, so that it curves into a “C” shape. It can be painful to move a hammertoe, and its abnormal position can make it rub against the inside of your shoe, which can cause a corn or callus.
The surgical approach to correcting hammertoe depends on the severity of the deformity and other considerations. If the toe is still flexible, correction may involve re-routing a tendon in the toe so that it pulls the joint into a straight position. If the toe has stiffened and become fixed in a straight position, the surgeon may cut ligaments, tendons and the end of the bone, and then use pins to straighten the toe. The surgeon may also remove portions of the joint and use pins to join the bones, allowing them to grow together as they heal. This joint fusion will limit the toe’s flexibility but leave it straight.
Complications after hammertoe correction are rare. However, there is a small possibility that the condition will come back, especially if there is an underlying biomechanical problem that wasn’t fixed during the surgery. It is also possible for bone healing to be delayed, or for a patient to develop a flail toe, which sticks up slightly instead of lying flat.
Additionally, a hammertoe correction carries the risks of any surgery, including infection, bleeding and damage to nerves or blood vessels, as well as risks related to anesthesia.
Types of hammertoe correction
Various treatment options are available to correct hammertoe, depending on the severity and length of the condition. Hammertoe correction treatments include:
- Changes in footwear—Since hammertoe is often a result of improper shoes, this will most likely be the first nonsurgical treatment recommended by your doctor. Wearing sandals or shoes with enough space for the toes to lie down will help alleviate hammertoe in its early stages. You will need to avoid high heels, pointed toes and shoes that are too small.
- Orthotic devices—A shoe insert used to provide extra cushion and support for your feet is called an orthotic device. You can purchase these at a drug store or your local sporting goods store. There are also custom-made shoe inserts that your doctor can prescribe for you. Changing the way your foot sits in your shoe is very helpful in treating hammertoe and its painful symptoms.
- Splinting/strapping—Your doctor or surgeon may use splints or small straps to realign the bent toe.
- Trimming corns and calluses—Your doctor can carefully trim the corns and calluses that form around the affected joints in your feet. Never attempt to do this yourself because the risk of infection from improper trimming is too great.
- Padding corns and calluses—Specially designed pads can be used to protect the corns and calluses from further irritation. Your doctor can recommend and prescribe the proper pads.
- Cortisone injections—This steroidal medication can be injected directly into the inflamed tissues surrounding the affected joints. This treatment will relieve pain and inflammation caused by hammertoe.
- Anti-inflammatory medications—Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen are used to help control pain and inflammation.
If nonsurgical treatment is ineffective or if the condition has progressed beyond nonsurgical means, then corrective surgery will be recommended. The two common types of correction surgery include:
- Arthroplasty—During this procedure, the surgeon will remove small parts of bone on either side of the middle joint in the toe. This helps the toes to uncurl and straighten out.
- Arthrodesis—This procedure is reserved for cases in which the hammertoe has progressed severely and caused the affected toe to become very stiff and rigid. The surgeon will fuse the small joint in the toe to straighten it back to its normal position. A small pin typically is used to hold the joint in place as the toe heals. The result of this surgery is that the hammertoe is corrected, but you will be unable to bend your toe again.
What to expect
Treatment of hammertoe starts with a consultation with a doctor to determine the best approach. If you are still able to bend the toe, the doctor may recommend simple lifestyle changes, which are often effective for less severe cases of hammertoe. These include switching to roomier, low-heeled shoes, using inserts or orthotics, and doing exercises to stretch and strengthen the muscles of the toe. If a conservative approach doesn’t work or if the hammertoe has stiffened and can’t be bent, surgery may be appropriate.
Hammertoe correction is usually done on an outpatient basis, meaning that the patient can go home the same day. The procedure may be done while you are awake, using medication to numb the foot, or you may be given general anesthesia to put you to sleep.
The surgery should not hurt, although some pain is likely after the procedure. It is not possible to drive immediately afterward, so you should arrange for transportation home.
Recovery from surgery to correct hammertoe usually takes a few weeks, although swelling may last up to a year. Your doctor may prescribe a special shoe to help with balance and make it easier to walk as the toe heals. It is important to keep weight off the foot for several weeks, so you may also be asked to use crutches or a walker for a period of time. It is also helpful to keep the foot elevated as much as possible in the weeks after the procedure, in order to reduce swelling and pressure on the toe and encourage healing. Depending on the affected foot, driving may not be possible for some time.
The doctor will likely remove the stitches, along with any pins or screws, a few weeks after the procedure. Exercises for the foot and toe can help speed healing, and may also prevent hammertoe from coming back.