Hammertoe occurs when a toe contracts and becomes bent because of an imbalance between the tendons on the top and bottom of the toe. According to the American Podiatric Medical Association, hammertoe usually affects the second through fifth toes. The condition worsens over time and will require surgery if more conservative treatment methods fail to correct the problem. Several surgical procedures are available to treat hammertoe.
In addition to bending of the toe, hammertoe symptoms include pain on the top of the toe when wearing shoes, redness, swelling, pain at the base of the toe or difficulty moving the joint. If you have a hammertoe, you might also develop corns if your toe continually rubs against your shoes. Injury, heredity and arthritis can contribute to the formation of a hammertoe. Constantly wearing shoes that are too tight can also cause joint deformity in the toes.
Flexible hammertoes can still be moved at the joint and can be corrected without surgery. If you aren’t treated while your hammertoe is in the flexible stage, the joint might become rigid and unbending. It is at this stage that surgery is needed.
Phalangeal head resection, or arthroplasty, is used to remove part of the bone over the rigid joint. Once the bone section is removed, the toe is straightened. Tendons, the bands of connective tissue that connect muscle to bone, are cut and reattached in order to hold the toe in its new position. Tape or wire is used to hold the toe in place until it heals.
Joint fusion is used to permanently connect the joints in the toe, preventing a recurrence of hammertoe. This procedure is used if you have had a hammertoe on the affected toe before, if you have another toe problem in addition to the hammertoe or if your joint deformity is caused by a muscle or nerve disease. After a small section of bone is removed at the joint and the toe is straightened, a wire is placed through the toe joint. The wire is removed four to six weeks after surgery, allowing time for the joints to fuse.
Tendon release is used if the hammertoe is not particularly severe and the joint has not yet become rigid. Tendons that are too tight trap the joint in a bent position. During tendon release, the tendon is cut, allowing the joint to straighten. Tendon release is a minor procedure and might only require a few stitches.
After hammertoe surgery, you will need to stay off your feet as much as possible to avoid placing pressure on your toe. The toe will be swollen and painful initially, but those symptoms will gradually decline as healing occurs. It is important to keep the bandage on your toe dry to prevent infection. Stitches can be removed about 10 days after surgery. A week or two after surgery, depending on the type of surgery you have, you might be able to start wearing walking shoes with stiff soles.