Hammer time! Do You Need Hammertoe Surgery? Hammer time is only good when MC Hammer is singing the song! Having hammertoes is not so good. What exactly is a hammertoe? A hammertoe is most often a deformity of the second, third, fourth or fifth toe, but can even happen in the first toe. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammertoes are flexible and can be corrected with simple measures but if left untreated, they can become fixed and require surgery.
There are many causes of hammertoes and the most common seen in medical offices is usually called “biomechanical” cause. For example, if someone has flat feet either for years or newly developed, the flat foot is a very unstable foot and an unstable foot will need to utilize the toes to help stabilize the foot. The toes will begin to work harder every step of every day, grabbing the ground in a bent position. This is called flexor stabilization. After months or years of the toes working harder to stabilize the foot, they become unbalanced and weakened which causes the toes to contract in the hammer looking position. Another reason for hammertoes is wearing shoes that don’t fit properly. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out.
The good news is that hammertoes are treatable. Most podiatrists will start with conservative treatment consisting of supportive shoes with a wide toe box, arch supports or custom orthortics and sometimes toe splinting (buddin splint or crest pads). If conservative treatment doesn’t work, surgery is an option and typically has excellent results. The most common surgeries for hammertoes are either arthrodesis or arthroplasty. Arthoplasty is usually done on toes 3, 4 and 5. It is a surgical procedure done in an operating room under sterile conditions where a small section of bone is removed from one of the two joints in the toe. Sometimes a wire or k-wire is used to temporarily stabilize the toe while it heals. The wire is removed from the toe anywhere from 2-6 weeks after the surgery and is removed in the office. Arthrodesis is where one of the 2 joints of the toe is fused (usually the proximal joint). The cartilage is removed from the joint and some type of device is used to stabilize the toe until the fusion is done which is usually 6-8 weeks. Fusions and commonly done on the 2nd toe.
The post operative treatment is 3-4 months to heal and will include rest, ice and a few visits to the office. Swelling can occur in the toe for up to 6-8 months. Within a year, with appropriate post operative care and compliance by the patient, hammertoes can go back to just being toes, however, without proper shoes, it is possible that after surgery your hammertoe may come back.
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com