Hammer toes aren’t always a painful or uncomfortable condition. In some cases, the hammer toe doesn’t really affect day-to-day life.
But in other cases, a hammer toe can lose its range of motion, affect your gait, become painful, or cause your shoes not to fit properly.
In these cases, your doctor may recommend surgery. If you’re wondering what to expect with hammer toe surgery, we’ve covered all the details in this article.
Let’s have a look at all you need to know about surgery for hammer toes.
What Are Hammer Toes?
Hammer toe is a common, progressive foot condition where your toe bends upwards at the middle—proximal interphalangeal—joint. This causes the tip of the toe to point downwards, giving it the appearance of a hammer and the toe can no longer lie flat.
There are two stages of hammer toe; flexible and rigid hammer toe.
Flexible hammer toe is less serious as you’re still able to move the toe joint. At this stage, you’re still able to slow down the progression of the hammer toe by using hammer toe straighteners, toe wraps, or metatarsal pads.
Rigid hammer toes are more serious as you won’t be able to move the joint. This is caused by soft tissues and joints that have become tight, pulling the joint out of alignment. Often, this leads to the loss of function of the affected toe, and surgery is required to realign and restore the function of the affected toe.
Hammer toe doesn’t affect the big toe, but it often affects your second toe. It can affect the third and fourth toes as well.
You may experience pain when you’re walking, moving your affected toe, or wearing shoes. Corns or calluses may begin to develop on the top of the middle joint or on the tip of the toe, as it rubs against the inside of the shoe.
What Causes a Hammer Toe to Form?
A hammer toe is caused by muscle imbalances. This places excessive pressure on your toe’s tendons, muscles, and joints. Over time, the tendons, muscles, and joints weaken and they’re no longer able to keep the toe straight.
This causes the middle joint to bend and the toe to curl underneath your foot.
The muscle imbalance is often caused by acute pressure that’s placed on the bones of the foot, usually by wearing shoes with high heels or narrow toe boxes.
If you’ve injured your toes, foot, or ankle, you may be at a higher risk of developing a hammer toe.
Existing medical conditions such as rheumatoid arthritis, diabetes, or people who have had a stroke are also more susceptible to developing a hammer toe.
The structure of your foot may put you at a higher risk of developing a hammer toe, especially if you have flat feet or high arches. Both flat feet and high arches can lead to the muscles and tendons becoming tight, which could lead to hammer toes.
A bunion can force your second toe to bend towards the lesser toes. Your second toe will then be consistently flexed, leading to muscle weakness in the toe.
When Should You Consider Surgery?
You may want to consider surgery if you’re experiencing a loss of toe function, have pain on the toe knuckle, or if your hammer toe is interfering with your daily activities.
If you’re having difficulty finding shoes that fit you properly, have developed thick calluses on your toes, or you’re experiencing pain in the ball of your foot, you may want to consider surgery.
You may have noticed that your hammer toe has become rigid and that the condition has gotten worse. In this case, speak to your doctor about surgery.
What to Expect With Hammer Toe Surgery?
Hammer toe surgery is minimally invasive, where the affected toe is surgically realigned or made shorter.
Your surgeon will evaluate the severity of your hammer toe. The surgeon will then decide on what method of surgery to use to correct the hammer toe.
In most cases, the surgery is an outpatient procedure, where you’re given a local anesthesia and possibly a sedative. This allows you to go home on the same day and helps speed up the recovery time.
You would need to make arrangements for a loved one to fetch you after your surgery, as you won’t be able to drive on the day.
What Methods Do Surgeons Use to Correct the Hammertoe?
Depending on the severity of your hammer toe, your doctor may recommend one of the following procedures to correct it.
1. Joint Resection Procedures (Arthroplasty)
With this procedure, an incision is made on the top of the toe. Then, part of one of the two small joints of the toe is removed. This creates room for your toe to be re-aligned into a straight position.
Your surgeon may use temporary pins to help immobilize and stabilize the toe while you’re healing. These pins will be removed after a few weeks.
This surgery only involves the small joint of the toe and not the joint of the ball of the foot.
2. Bone-Mending Procedures (Arthrodesis or Fusion)
The surgeon will cut and remove both ends of the bone of the fixed joint, allowing the ends of the bones to fuse together—arthrodesis—as the bones heal. The tendons and ligaments will also be cut to keep the toe straight.
Your surgeon will then insert a pin or K-wire to temporarily keep the toe straight. Once the ends have fused together, the pin or K-wire is removed.
3. Toe Relocation Procedures
This procedure is often performed together with either the joint resection procedure or the bone-mending procedure.
If the affected toe is deformed at the ball of the foot, then the surgeon will reposition this joint, as well as the middle—proximal interphalangeal—joint. Tendons and ligaments will also be repaired to help keep the toe straight.
4. Tendon Transfer
If your hammer toe is still somewhat flexible at the joint, your surgeon may choose this procedure.
Your surgeon will carefully transfer tendons from the bottom of the toe to the top. This pulls the toe into its correct alignment, rebalancing muscle weaknesses and reducing pain.
How Long Is the Recovery?
Your recovery time will depend on your overall health and the type of hammer toe procedure that you had. With that being said, it does take up to 6 weeks for the bones, tendons, and ligaments to heal.
You may not be able to drive for a few weeks if you’ve had surgery on your right foot.
After the surgery, you may be given a stiff-soled surgical shoe to wear for about 2 to 4 weeks. This would depend on the technique used to stabilize the toe and the procedure that was performed.
Your doctor may recommend that you wear deep, wide, supportive shoes for between 6 and 11 weeks as your foot heals. Depending on how severe your hammer toe was and the procedure that was performed, you may return to normal activities within anywhere from 2 weeks to 3 months.
When you leave the hospital, your foot will be wrapped up in a bandage to help protect and keep the toe in the correct position. You may have to have the bandage changed or removed at the doctor’s office several days later.
The pins or K-wire may be taken out within 3 or 4 weeks and the stitches could be removed 2 to 3 weeks after the surgery.
You will have to avoid putting weight on your foot at first. Your doctor may recommend crutches or a knee scooter to help you get around during your recovery period.
Hammer Toe Surgery Aftercare
After your hammer toe surgery, you will experience swelling—which can last for up to a year—and some pain in the toe area.
Anytime you sit or lie down, place a pillow under your foot and try to keep your foot elevated above the level of your heart. Apply ice or a cold pack for 10 to 20 minutes each hour, as this will help to reduce swelling.
Keep the weight off your foot for at least 2 weeks and use the surgical shoe and crutches the doctor gave you to move around.
Make sure to keep the bandages clean and dry. If you’re going to bathe or shower—instead of sponge bathing—then wrap your foot up in a plastic bag, so that water can’t get in.
If your doctor gave you a prescription for antibiotics and pain medication, then take them exactly as directed. If your doctor didn’t prescribe pain medication, then speak to them about over-the-counter medication that you can use.
Make sure to take all medication after meals, unless your doctor has specifically told you not to.
Speak to your doctor about when you can start taking your medicines—if you have chronic medicines—such as a blood thinner, aspirin, or beta-blockers.
Your doctor may give you exercises to do that will help improve muscle strength in your feet. Follow the instructions that they gave you, as this can help with the healing as well as help keep the muscles balanced.