Different Types of Hammertoe Surgery

Hammertoes are deformities of the lesser toes, which are all the toes except for the big toe.

The deformities can be classified as flexible or fixed in that sometimes they can straighten themselves out by manual manipulation, and in other cases they have become stiff and fixed at the middle joint known as the interphalangeal joint, resulting in pain and corn formation.

This causes difficulty with footwear, as patients often find that the middle joint rubs against shoes. They also have a poor cosmetic appearance.

In some cases, individuals are born with long second toes known as Morton’s toes, which eventually results in hammertoe deformities.

Non-surgical versus Surgical Treatment

Non-surgical treatment initially can involve varying insoles to support the arch and reduce the tendon function. Sometimes manipulation of the toe and stretching the tendons known as flexor tendons can help treat these and straighten them.

Once the deformity is fixed, then only surgery can straighten the toes. Surgery would generally involve either removing the joint or fusing the joint to decompress. There may be additional tendon procedures and releases that may be required.

Types of Hammertoe Surgeries

There are different types of hammertoe surgery, but they broadly fit into two categories known as arthroplasty or arthrodesis, also known as fusion.

Arthroplasty

Arthroplasty removes part of the joint so that space is created and the toe can be relaxed. Soft tissue is sometimes placed in between so that bone ends are separated. This particularly works well with the fourth and fifth toes, as they do not require as much stability as the second and third toes

Arthrodesis

The second and third toes require greater stability and are more suited to an arthrodesis procedure, known as a fusion procedure. The procedure can be done with a screw or a wire placed to allow the bone to become one.

The recovery does differ in patients requiring fusion. The use of intermedullary implant devices which stay within the bone itself allow earlier return to shoes at two weeks, whereas using a wire which sticks out the toe can remain in place for six weeks where you have to wear a specialist shoe for that period.

More recently, minimally invasive hammertoe surgery involves using a keyhole procedure to place a screw or an implant within the joint and correcting the deformity. In some cases, minimally invasive hammertoe surgery can be used without any wire or screw fixation and where strapping for three to five weeks is required.

Tendon release

Other procedures such as tendon releases can be performed in very flexible deformities, especially in younger patients. Where the deformity can be easily corrected, no bone surgery is required in those patients.

Recovery and Post-surgical Care

Recovery from hammertoe surgery requires initial two weeks or more rest, complete rest of no more than 10 minutes an hour.

Following that, you can gradually increase your activity over a six to eight week period. You can return to desk-based jobs at seven to ten days, but if you require a manual job, then it may be up to six weeks that you’ll require to take off work.

Know More: Hammertoe Surgery Recovery Week by Week

Frequently Asked Questions

Q. What is the best surgery for hammertoe?

A. The best surgery for hammertoe depends on the degree of the deformity and the rigidity. In minor cases, you can perform tenotomy procedures or a tendon release procedure. In more severe cases, you will require fusion of the joints or an arthroplasty procedure.

Q. What is a surgical technique for hammertoe?

A. The surgical technique for most hammertoes is a fusion, as it provides long-term stability. It can be used with internal screw fixation devices, such as an implant, and provides a more predictable outcome.

Q. Can hammertoes return after surgery?

A. Yes, hammertoes can return after surgery, but the incidence of this is low and approximately 2%.

Q. How can I permanently fix my hammertoes?

A. The most permanent technique is by surgery, which either involves fusion or arthroplastic procedure.

Q. What is the best exercise for hammertoe surgery?

A. Exercises for hammertoe surgery involve stretching the tendons by placing the toe straight and stretching the end of the toe upwards.