Hammer toe surgery

Hammer toe surgery

Hammer toe surgery is often the preferred method to prevent the situation from deteriorating. It is important to understand the causes and the different ways to treat this condition to get rid of your pain and regain your peace of mind.

What is hammer toe?

Hammer toe affects a large number of men and women around the world. This toe deformation can be very problematic if nothing is done to treat it.

This deformation of the toes can be divided into 3 categories:

Hammer toes: this is the most serious of the three types of deformations. This condition appears when the joint above the toes protrudes so excessively that it causes friction against the shoe. This friction eventually causes significant pain while walking. It is essential to consult quickly to prevent this condition from worsening. Hammer toe surgery may then be required. 

Claw toes: this is the 2nd most common deformation of the toes. It also causes pain on top of the toes, in addition to forming corns and a thickening of the toenail.  It is a nuisance that requires rapid attention during a consultation. And surgery may be considered, depending on the individual case. 

Mallet toes: this phenomenon is less common and occurs when the mallet-shaped toes change shape and only bend at the tip. Corns can also appear at the tip of the toes. However, this condition is less serious, with more moderate pain. Surgery is rarely required.

Patient expectations

A good podiatrist must listen to you and understand your expectations. However, they will also have to explain that hammer toe surgery will not always make your toes as straight and flexible as before.

Some deformations progress so much that the results can vary. In certain very rare cases, some more draconian measures may be suggested, such as amputation of the toe. 

Regardless of the method chosen by your podiatrist, remember that the primary objective of this operation is to stop the pain and allow you to remain active.  

When should a patient elect to seek surgery for hammer toe?

If you can no longer wear your shoes or perform your daily activities without pain, it is imperative that you book a consultation. Your podiatrist will then decide if surgery is necessary. Some conservative treatment methods can be tried initially. 

How can we recognize possible biomechanical complications and other special cases? 

The podiatrist has been specially trained for this purpose! Consulting a podiatrist helps to avoid future complications with your feet and prevent certain problems. 

Given that our feet are subject to so many demands, the slightest imbalance can trigger the start of a new pathology, such as capsulitis, corns or various foot stress fractures. 

How do you choose the right foot surgeon? 

Below are a few tips to help you decide: 

Favour a surgeon with experience

Study their background, see what they have accomplished, read reviews, ensure they have received proper training, etc.

Make sure they can offer you personalized surgical care

Remind yourself that the simplest solution is not always the best! Your podiatrist must know all types of procedures and be able to adapt their methods to your specific condition. 

Opt for a humane approach

You must have confidence in your surgeon. To succeed, mutual respect is essential. The podiatrist must listen to you and show compassion. They must also be able to properly explain your condition and the ways to treat your foot. 

Favour availability

If you have an urgent need for foot care, your podiatrist must be readily available to provide care. That’s why it is important to choose a professional who is available when you need help. 

PiedRéseau clinics have the podiatrists who meet all these criteria! 

How do we evaluate whether a patient requires surgery for hammer toes?

Your PiedRéseau clinics enable you to seek treatment across Québec in one of its affiliate clinics. A local podiatrist will evaluate you, provide a summary of your condition and will communicate with a podiatric surgeon as required.

You are then free to decide whether you want to proceed with the hammer toe surgery plan your podiatrist will give you. 

The patient’s medical history is important for proper treatment

Based on your medical history, the podiatrist will be able to determine the reason for the deformation of your toes. Several causes can explain it, bunions or foot injuries in particular, wearing of certain types of shoes or various diseases. 

Clinical examination

The clinical examination is used to assess whether you must undergo surgery. Your medical history medication you take and any other relevant medical condition will be studied. A vascular assessment of your feet will also be conducted. 

Functional limitations 

During the physical evaluation, the podiatrist will consider the various functional limitations of your foot in order to establish a personalized treatment plan. For example, the podiatrist will not select the same type of surgery if you are suffering from arthritis, if you have mobility restrictions or if you suffer from inflammatory disease. 

Available movement

In order to perform proper hammer toe surgery, the podiatrist will need to evaluate the available movement in your foot joint. This will give them an idea of what to expect. The podiatrist will be able to determine if the foot mobility can be maintained as it is.

Based on this information, you will then be able to decide whether you want to proceed with the proposed surgical plan. You will have the opportunity to weigh the advantages and disadvantages of surgery.

X-ray evaluation of the deformation

An initial bone evaluation will be conducted. This is another essential step in establishing your hammer toe surgical plan. This X-ray allows you to reposition the joints of your toes and check your foot’s bone alignment.

A second X-ray is then taken during or after the operation to observe the results and make any relevant decisions. 

Conservative treatment methods

Before starting the process for hammer toe surgery, it is important to identify other alternative methods that could be tried (and check those that have already been tested). 

These conservative treatment methods may include:

  • Wearing wide, flexible footwear
  • Wearing orthotic devices
  • Various exercises to increase joint flexibility
  • Using a gel cushion and gel orthotics around the toes

However, some cases can only be resolved by surgery. 

Why choose surgery performed by a podiatrist?

The podiatrist has received in-depth training to care for your feet and conduct a biomechanical evaluation. They are the professional of choice to perform specialized procedures on your feet.

Below are several other advantages offered by your podiatrist: 

  • Foot care management from A to Z
  • Extensive knowledge to return maximum autonomy to your foot
  • Personalized follow-up and sound advice

Procedures for straightening hammer toes

Below are the most common methods: 

Arthroplasty

The goal of this procedure is to restore toe balance without restricting movement. This is an interesting choice for an operation if your toes are still flexible. However, the risk of recurrence is higher. 

In order for arthroplasty to work, it is imperative to follow the instructions to the letter; otherwise you could create new problems for your feet.

Arthrodesis

Arthrodesis allows the toes to be straightened. The podiatrist fuses the deformed joint to strengthen your foot. This procedure stabilizes your toe and reduces the risk of recurrence to almost zero. 

This is a solution for those who have already lost their toe function, because they will not notice any difference in toe rigidity. 

Hammer toe amputation

Sometimes the most serious situations require amputation of the toe. This is naturally a last resort. However, this procedure allows for quick and complete healing. If your toes are at risk of ulceration or are too severely deformed, this may be an option to be considered. 

Sometimes bone surgery is possible to avoid amputation. Sometimes bunion surgery is also required to create space to realign hammer toes. 

Complex procedure

In some very specific cases, the podiatrist may combine 2 types of hammer toe procedures together. 

Chronological steps of surgery

The procedure can be divided into 4 steps: assessment, preparation, surgery and post-surgery: 

Pre-surgery assessment

This step can be performed several weeks before the procedure. The proposed treatment plan is presented to you at the time and you choose the best option.  

Surgical preparation

Surgical preparation begins several weeks before the surgery:

  • You must obtain medical clearance from your doctor.
  • You may have to take certain antibiotics. Blood samples can also be taken.
  • Plan on a lot of rest time following hammer to surgery.
  • You must be accompanied by someone for the surgery, and they must be available to take you home and stay with you for 24 to 48 hours.
  • Your feet must be properly cleaned.
  • It may be necessary to fast for 12 hours before surgery.

Normally, hammer toe surgery does not require a local anaesthesia or IV sedation.

The day of your surgery

Below is the sequence of your operation: 

  • If prescribed, you must take any pre-surgery medication as per the instructions of your podiatric surgeon. 
  • The surgical team cares for you and ensures you are comfortable.

This surgery requires a local anaesthesia. You will be given an oral sedative to reduce any possible stress.

Back home

Things to know to ensure proper healing: 

  • It is normal to feel the effects of the anaesthesia after your operation.
  • Pain medication must be taken on a regular basis.
  • You will return home the same day as the operation (don’t forget to bring someone with you to assist you!).
  • Keep your leg elevated and apply an ice pack to reduce any swelling.
  • You must always keep your foot dry.

It is especially important not to touch your bandages, unless otherwise directed by your surgeon. 

Follow-up visits and home care

Hammer toe surgery requires special care at home. The clinic’s team will give you a personalized home care plan to follow. A follow-up appointment will then be scheduled with your surgeon within a week to monitor your progress.

Normally, stitches last from 10 to 21 days.

What is the convalescence period for hammer toe surgery?

Since each case is different, it is up to your podiatric surgeon to answer this question. However, you must generally plan for 3 to 8 weeks, and sometimes up to 12 weeks of convalescence.

When will I be able to recommence my daily activities?

It takes about 2 months to return to your normal lifestyle. It all depends on the procedure performed and the speed of healing. Often you can practise walking beforehand with an adapted shoe. 

If you play sports, you will usually have to wait longer. 

Importance of following your surgical recommendations to the letter

One thing is important to remember, it is necessary to follow your surgeon’s instructions to the letter. Not doing so could jeopardize your healing process and create numerous complications. 

You must also be disciplined to regain your normal mobility. 

Post-surgical plantar orthotics

Hammer toes often develop on feet with common biomechanical deficiencies. Wearing foot orthotics is a solution often adopted to correct these problems.

Orthotics promote your foot’s healing, reduce the risk of recurrence and help avoid new surgery in future.