What is a hammertoe?

A hammertoe is an abnormal positioning of one or all of the lesser toes. This is typically a bending down of the middle knuckle of the toe and bending up of the joint where the toe attaches to the foot. Many times the toes sit up off the floor and cause increased pressure on the ball of the foot or rub on shoes. They can also press against one another and cause painful calluses.

What can be done to treat hammertoes?

Conservative treatment options include:
toe spacers to keep the toes apart
foam or silicone sleeves to protect the toe
a “crest pad” which sits under the toes to keep them from pressing against the ground
trimming down painful calluses which may form
wearing shoes with extra depth and width in the toe box to accommodate the change in shape of the toes
These options are best for patients with poor circulation or those with mild deformities.

Surgical options include:
Minimally invasive straightening in the office
Removal of half of the knuckle (arthroplasty)
Removal of the entire knuckle and fusion of the toe bones (arthrodesis)
Release of the tight foot joint holding the toe in an extended position (up)
Use of pins, screws, or implants to hold the toe straight

What is it like after surgery?

Depending on the number of toes that need to be repaired, the post-operative pain ranges from mild to moderate. Stitches stay in for 2 weeks after surgery. If pins are used, they are removed in the office three to four weeks after surgery. Other implants or screws stay in permanently. The objective of surgery is to make the toes stiff and straight. This helps to keep them permanently stable, so they no longer cause problems. Patients are typically back into normal shoes 4 – 6 weeks after surgery. Prolonged swelling of the toes may last for up to 6 months after surgery, but this is typically not painful and does not cause problems.

Minimally invasive hammertoe repair is only effective for mild and semi-flexible deformities. It is performed under local anesthetic in the office. A sharp needle is used to release the tight tendons and joint capsules which are holding the toe flexed. Following this procedure, the toes are held in a straight position with band aids or tape for 2 weeks. Patients typically have little pain and can return to full activity immediately following this procedure.