Hammer toe surgery

Hammer toe is one of the most common foot deformities. It is typically the deformation of one or two toes (the second and the third toes), which basically means that the furthest phalanx is raised, and the second and the third phalanges turn toward the foot, forming the characteristic V shape. It can also occur that the great toe’s deformity does not allow more space for the rest of the toes, and a toe gets above another.

What causes lead to a hammer toe?

Its causes include a complex forefoot deformity, disintegration of the foot statics, a dropped transverse arch.

The second and/or the third toe is more commonly, and the fourth toe is rarely deformed; the furthest phalanx is raised, and the two other phalanges drop due to the pulling of the tendons; the toe gets misaligned in a V shape.

Since it is a disease that develops gradually, more and more load is focused on the base of the toes, then a slow rearrangement starts, thus a hammer toe most commonly does not present on its own, but it is associated with a bunion of the great toe. The forefoot is widened, but the toes still get jammed due to poor loading; the flexor tendon of the middle phalanx gets shorter, and the extensor tendon of the closest phalanx gets stretched. After a while, this unevenness leads to such a severe deformity that it causes difficulties in wearing shoes, and hard, painful skin calluses at the angulation on the upper surface of the toe.

What are the causes and what does this orthopedic pathology mean?

• The transverse arch drops, the forefoot gets wider, and consequently, one or more toes get angulated. The toes are fixed in the pathological position.
• The toe gets heavier and inflamed due to the painful skin callus.
• All of these are caused by the disintegration of the balance of bones, tendons, and muscles.
• The joint capsule gets inflamed and thicker due to the tightness.
• The joint’s range of motion is reduced because of the soft-tissue shortening.
• Movement and loading become painful, and the toe often does not fit into the shoe.

Which are the main symptoms of a hammer toe?

• Pain that is characterized by:
  • A burning sensation, constant irritation.
  • Increasing on load.
• Reduced range of motion, stiffness.
• Reduced ability to walk and walking distance.
• Difficulties in wearing shoes.
• All of the above lead to limping.
• Inflamed wounds.
• Deformity causing esthetic problems.

What treatment options are available?

Basically, there are two treatment options available:

Non surgical (conservative) treatment

Aims:

• Reducing pain
• Blocking the toe and forefoot deformities from growth
• Reducing limping

Methods:

• Pharmacological treatment:
  • Anti inflammatory drugs
  • Painkillers
• Other treatments: foot exercises, wearing insoles for flat feet or orthopedic shoes, silicone pad supporting the hammer toe.

Surgical treatment

The physician may recommend surgery, if the non-surgical treatment methods are no longer effective, and the diagnosis is confirmed by clinical examinations and X-ray scans. It is important to select the time of the surgery, which depends on the patient’s pain tolerance, and the level of progression (aggravation).

Based on the current condition of the affected bones and soft tissues, and also the complaints, your physician will recommend surgery, if the deformity is so severe that it reduces the quality of life, and it cannot be corrected by any other method.

• The deformed toe is positioned into its normal, anatomical position.
• The intervention starts with the surgical opening (arthrotomy) of the joint from an incision that is made at the level of the angulation, over the toe. Then, the physician removes the emerged head of the toe’s closest phalanx and corrects the sharp bone edges. If necessary, the stretched tendon is constricted with a stitch.
• Your physician will remove the painful skin calluses depending on the deformity’s severity.
• The achieved corrected (restored) bone position could be secured with screws or other metal implants, if necessary, in which case, the use of an X ray image intensifier may become necessary (certainly by taking the radiation protection precautions).

The surgical process:

• The joint is explored from an incision made above the hammer toe.
• The above described surgery is performed.
• Rarely, a suction drain made of silicone is inserted into the surgical site due to the accompanying postoperative bleeding.
• The wound is closed after thorough surgical hemostasis.
• In line with the extent of bone removal, axis correction, ligament release and restoration, a cover dressing with an elastic bandage, or a redressive dressing is applied (it maintains the position, and it is corrective).

What happens if the justified surgical treatment is not performed?

• The pain is expected to increase further.
• The axis deviation and movement disability may aggravate.
• The quality of life keeps deteriorating.
• The effectiveness of a surgery performed later may decrease.