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Hammer Toe Correction

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Hammer toe occurs when there is a shortening of the tendon that controls toe movement. This causes the middle joint of the toe to be bent upward and the outer joint downwards. The misshapen toe resembles a hammer. A hammer toe correction is done to correct a toe deformity called a hammer toe .

Hammer toe

Reasons for Procedure

A hammertoe correction is considered when:

Other treatments have failed to bring about results.
The affected toe has assumed an awkward position and is causing pain.
The deformity makes walking difficult.
The position of the toe causes breakdown of skin. This can increase the risk of developing a bone infection.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have the correction, your doctor will review a list of possible complications, which may include:

Infection
Bleeding
Excessive swelling, although the toe will normally be swollen for 4-8 weeks following surgery
Anesthesia-related problems
Recurrence of hammer toe
Nerve or blood vessel injury to the toe

Factors that may increase the risk of complications include:

Smoking
Diabetes
Bleeding disorders
Poor circulation

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical exam
X-rays

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

Aspirin or other anti-inflammatory drugs
Blood thinners

The day of the procedure:

Arrange for a ride to and from the procedure.
Arrange for help at home after the procedure.
Wear comfortable clothing that is easy to remove.

Anesthesia

Local anesthesia is often used. It will numb the area. Spinal anesthesia may also be used. This anesthesia will make your lower body numb.

Description of the Procedure

Several surgical options are available for hammer toe correction. Some corrections can be made with changes to soft tissue. Others need to be made to the bone.

Soft Tissue

This is usually best in patients under 30, with limited toe deformity. A cut is made in the skin and the tendon is released. Sometimes it is reattached to a different area of the bone. The changes in soft tissue will allow the toe to relax and eliminate the deformity.

Bone

Two common methods of hammer toe correction on the bones themselves are joint arthroplasty and joint fusion. The type of procedure used depends on the deformity. A combination of procedures may be needed. In both cases, a cut in the skin is made over the toe joint.

During an arthroplasty, part of the bones on both sides of the middle toe joint may be removed. This will allow the toe to uncurl.

During a fusion, the ends of the toe bones are removed. The bones are then repositioned. The repositioning is usually held together with a pin placed within the bone. The pin may be removed after 3-4 weeks. Other changes to the anatomy of the foot due to the hammer toe may also be corrected at this time.

The incision will be closed with stitches. Dressings will be applied to hold the toe in proper position.

How Long Will It Take?

This depends on the procedure and the number of toes corrected.

Will It Hurt?

Anesthesia prevents pain during the surgery. You will be given medicine to manage pain after the surgery.

Post-procedure Care

During the first couple of days, keep your foot elevated most of the time.
Limit standing and walking, and stay off your foot as much as possible.
Use crutches or wear a special open-toed, wooden-soled shoe, as directed by your doctor .
Ask your doctor about when it is safe to shower, bathe, or soak in water.

The corrected toe may be slightly longer or shorter than before surgery. The toe will not move as much as a normal toe. Expect some swelling and redness, which may last for several months. Your dressing may need to be adjusted as swelling decreases. If it appears that the deformity may recur, your doctor may choose to continue with dressings for another 2-4 weeks.

Select shoes with plenty of space for your toes. Poorly fitting shoes contribute to hammer toe development.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Pain that you cannot control with the medicines you have been given

In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org
The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Calgary Foot Clinic http://www.foottalk.com
Nurses Entrepreneurial Foot Care Association of Canada http://www.nefca.ca
Canadian Podiatric Medical Association http://www.podiatrycanada.org

References:

Hammer toe. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00160 . Updated September 2012. Accessed May 2, 2013.
Campbell's Operative Orthopaedics. 9th ed. Mosby-Year Book; 1998.
Murphy GA. Campbell's Operative Orthopaedics. 10th ed. Philadelphia; Mosby, Inc; 2003.
6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last reviewed May 2013 by John C. Keel, MD; Michael Woods, MD

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