Hammer toes (HT) are a condition where the small joints of the toes develop a rigid flexion or extension deformity due to imbalances in the tightness of the joint capsule and tendons on the top and bottom of the toes.
Hammer Toes(HT) is primarily due to genetics but occurs frequently with bunions, rheumatoid arthritis, nerve damage and high arches with a fallen metatarsal arch. A HT is not painful, but wearing tight shoes that press on the raised joint can create pain, skin irritations and synovitis (inflammation). Pain in the ball of the foot (metatarsalgia) is more likely to develop with a HT.
First line treatment for hammer toes involves conservative treatment measures. This includes custom soft orthotics with a metatarsal pad to support the arch and take some of the pressure off the ball of your foot. Modifying your shoe wear with simple stretching can alleviate pressure over the top of your toes. Foot care accessories including silicone toe sleeves, budin splints and sling taping can help avoid unwanted irritation. If your developing metatarsalgia as a result of the hammertoes, injections of corticosteroids can help alleviate some of the inflammation.
What about hammertoe surgery?
The Proximal Interphalangeal (PIP) is the first joint of the small toes. The indication for surgery is when this joint has a fixed curved (Clawtoe or Hammer Toe) deformity and when the deformity is producing enough pain or functional limitations to warrant surgery. The deformity develops gradually and cannot be straightened because it is bent and fixed in this position for a long period of time (rigidity). The procedure essentially straightens the joint and fuses the proximal and middle phalanx (toe bones) in the straightened position. The joint is then fixed in the straightened position with a wire. This will result in a straight toe without any ability to flex.
Recovery from a PIP joint fusion typically takes about 6 weeks, although the toe can remain swollen for much longer. During this time, it is usually necessary to keep the joint immobilized in the new position. It’s sometimes possible to have the patient weight bear through the heel during this period. If a wire (pin) is used to maintain the toe in a straightened position, it will be removed approximately 6 weeks post-surgery.
- Infection around the wire penetration site. If a wire is used to maintain the position, keeping the tip of the toe clean is very important until the pin is removed. This normally needs to stay clean, dry, and protected from possible trauma.
- Swelling of the toe. The toe can remain swollen for many months. It is not uncommon for swelling to last upwards of 6-12 months after surgery.
- Malposition. It is not uncommon for the joint to be fused in a slightly off-centered position, which in some instances can be problematic.
- Blood Vessel (Vascular) Injury. There are two small blood vessels that run on either side of the toe. If these are injured, the blood flow to the tip of the toe may be lost. This can result in necrosis of the tip of the toe. Although rare, this may lead to a second surgery and partial amputation of the toe.
- Residual pain: As the toe is a relatively confined space, it’s not uncommon to have swelling and residual pain for an extended period of time
- Toe Shortening: By removing a small piece of bone prior to fusion, the toe will be slightly shortened.