What is a Hammertoe?
Hammertoes occur when the smaller toes of the foot become bent and prominent. The four smaller toes of the foot are much like fingers in the hand. Each has three bones (phalanges), which have joints between them (interphalangeal joints). The toes form a joint with the long bones of the foot (metatarsals) in the area that is often referred to as the ball of the foot.
Normally, these bones and joints are straight. A hammertoe occurs when the toes become bent at the first interphalangeal joint, making the toe prominent. This can affect any number of the lesser toes. In some cases, a bursa (soft tissue swelling) forms over the joint and can become inflamed (bursitis). With time, hard skin (callus) or corns (focal areas of callus) can form over the joints or at the tip of the toe.
Hammertoes have many causes, but commonly an imbalance between the flexor and extensor tendons causes the toe to bend out of normal position. Some foot types such as very flexible feet, high arched and flat feet may be more prone to hammertoes. Footwear and certain activities may exacerbate the symptoms of hammertoes, but are not generally the underlying cause.
Generally, the deformity becomes worse with time and slowly becomes rigid or fixed. This can cause discomfort in shoes. The position of the toe places increased stress on the ball of the foot and can become painful. Corn and callus formation on the ball of the foot is not uncommon. In some cases, the joint capsule ruptures, causing the toe to sit up in the air or drift toward the big toe.
Hammertoe Treatment – Conservative and Surgical
Conservative care for hammertoes includes accommodation of the deformity with wider, softer, and deeper footwear. Padding of the toes and trimming of painful corns and calluses can provide relief of painful symptoms. Stretching of the tendons to the toes and use of custom foot orthotics may slow the progression of the deformities.
Surgical care is the only way to fully correct a hammertoe. The goal of surgery is to alleviate pain that has not gotten better with non-surgical treatment. If you have pain or cannot comfortably wear shoes after trying non-operative treatments, hammertoe surgery may be an option.
Most often, hammertoe correction is done as an outpatient procedure. This means that you can go home the same day as the surgery. The surgery can either be done with you fully asleep, or most often can be done with light sedation and a local anesthetic.
Specific Techniques for Hammertoe Surgery
Flexible Hammertoes: If your hammertoe is flexible and your toe can be manually straightened, a tendon release or tendon transfer procedure may be used to correct the problem. A tendon release often requires a small stab incision on the bottom of the toe to surgically incise the tendon to relax the toe into a straight position. A tendon transfer involves rerouting the tendons from the bottom of the toe to the top of the toe where it is prominent. This helps pull the bent joint into a straight position.
Rigid Hammertoes: If your hammertoe has become rigid or stiff, there are two options for treatment. Joint resection can be used to treat the fixed hammertoe. In this procedure an incision is made over the top of the toe. Ligaments and tendons may be cut to help with straightening the toe. The end of the bone is removed to allow the toe to straighten completely. A pin may be temporarily used to hold the toe straight and is usually removed three to four weeks after the surgery.
Fusion can also be used to treat rigid hammertoes. In this procedure, the ligaments and tendons are cut to help straighten the toe. The ends of the bone are cut and the toe is straightened. Temporary pins or internal implants may be used to keep the toe straight while the bones heal together.
Surgical Aftercare and Potential Complications
You may be given a special shoe to wear after surgery to help with walking. Recovery normally takes several weeks depending on the type of procedure that was done. Stitches are usually taken out within the first two weeks after surgery, and if pins were placed, these will be taken out within a few weeks.
You may not put your foot in water until the stitches and pins are removed. Swelling of the toe or toes is normal after hammertoe surgery. It may take several months before the swelling fully resolves, however, most of the discomfort is gone within the first several weeks following the surgery.
There are possible complications after surgery for hammertoe correction that relate to surgery in general. Infection, damage to nerves and vessels, bleeding, blood clots and risks related to anesthesia are all possible.
Complications specific to hammertoe surgery include a small chance that the hammertoe may come back after your surgery. There is a risk that after the surgery you may feel like the toe is unstable. This is due to the cutting of ligaments and tendons. If you have a fusion there is a small risk of the bones not healing. These complications are all rare. Discuss the potential complications with your surgeon prior to undergoing hammertoe correction.
Dr. Andrew Bernhard and Dr. Brian Maurer of Eagle-Summit Foot & Ankle in Frisco and Avon, Colorado are on the forefront of surgical advances in foot and ankle care. For more information contact Eagle-Summit Foot & Ankle.