Hammertoe surgery: options and recovery

Is surgery right for me?

For background on the condition, see hammertoes. Surgery is generally offered when:

• the toe has become rigid and can no longer be straightened by hand
• pain persists, or corns and calluses keep returning, despite appropriate shoes, padding and other non-surgical care
• the toe has caused an open sore or ulcer^[2,3,4]

Hammertoe surgery is often combined with correction of a bunion or with a procedure at the joint at the base of the toe, because the same underlying imbalance may be affecting more than one part of the forefoot.^[1]

The main types of operation

Options fall into soft-tissue procedures and bone procedures, and they are often combined.^[1]

• Tendon lengthening or transfer. For a flexible toe, tightness in the flexor tendon on the underside of the toe can be released or rebalanced, sometimes by transferring it to the top of the toe to help hold it straight.^[2]
• Joint resection (arthroplasty). For a rigid toe, the surgeon removes the end of a bone at the bent joint so that the toe can be straightened, leaving a flexible, fibrous joint.
• Joint fusion (arthrodesis). The bent joint is fused so the toe stays straight. Fixation can be a temporary wire that is later removed, or an implant that stays inside the bone.
• Release at the base of the toe, and, when needed, shortening of the metatarsal, to balance the joint at the toe’s base.^[1,4]

What do the studies show? In a randomized trial comparing removal of the joint with fusion, there was no significant difference in pain and foot-function scores at one year; both gave good to excellent results. Fusion resulted in better alignment of the toe in the side view.^[5] A systematic review comparing wires with newer internal implants found higher union rates with the implants, but no clear advantage in pain, satisfaction, foot-related function or complication rates.^[6]

Minimally invasive (percutaneous) techniques use tiny incisions and small instruments to release tendons and shape bone, and they are gaining popularity; their indications and results are still being studied.^[7]

Recovery

Hammertoe surgery is typically done as an outpatient procedure. Weight-bearing on the foot in a protective shoe is often permitted right after surgery, while the toe is protected. Expect stiffness and swelling for about four to six weeks, and limit activity while the toe heals.^[2] The timeline varies with the procedure, so follow your surgeon’s instructions about dressings, wires or pins if they are used, footwear and return to activity. See recovery after foot and ankle surgery.

Risks

All surgery carries risk. Those specific to hammertoe surgery include recurrence of the bend, ongoing stiffness and swelling, numbness or sensitivity, a toe that stays shorter or that doesn’t touch the ground, infection, and problems with the fixation or with healing of a fusion. In people with diabetes or reduced circulation, healing problems and infection are more likely.^[5,6,8] See preparing for foot and ankle surgery.

Questions to ask before deciding

• Is my toe flexible or rigid, and how does that change the operation?
• Which joints do you plan to treat, and will other procedures be done at the same time?
• Will wires or pins be used, and when are they removed?
• What shoes will I be able to wear afterward, and when?

When to seek care