What is a hammertoe?
Hammertoe is when the tendons of the lesser toes contract and cause a bend or flexion of the middle joint of the small toes. Hammertoe can be flexible where the toe can still be straightened or fixed where the toes are permanently flexed. One or multiple toes may be affected on the same foot. Hammertoe deformity is more common in women than in men, this is thought to be due to women wearing tight shoes with points. Hammertoes start slowly and get worse over time. These occur more often as we age. Other causes include trauma to the toe such as jamming, a muscular imbalance, and the second toe being longer than the first and/or other diseases such as rheumatoid arthritis.
It is important to obtain a thorough history in order to properly treat a hammertoe. It is important to know where pain is the worst to know what treatments are needed. Some patients describe pain in the ball of their foot where the metatarsal head is being pushed into the ground more than usual. Some may have pain on the tip of their toe due to increased pressure. Other complaints include callus formation at the bend in the toe from rubbing on shoes, on the tip of the toe and/or on the ball of the foot. Flexibility of the toe will also be examined to help decide correct treatment. X-ray of the foot will be taken to evaluate joints and check for any possible fracture.
Non surgical options used to treat hammertoe include wearing shoes with a wide toe box to prevent direct pressure to the hammertoe. It is also important that the top of the toe be protected to prevent wounds from forming. Cushioned pads such as a corn pad can be used to protect the toe as well. A pad may be used to offload the front of the foot to relieve pain. Hammertoe splints are also available to straighten the toe and relieve the pressure on the tip of the toe. These are helpful if the hammertoe is flexible. Exercises can also be helpful to stretch the toe and strengthen the muscles. Exercises include picking up objects such as marbles with your toes. Massage may also be helpful.
If non-surgical treatments fail and there is significant pain or wound problems surgery may be indicated. The specific surgery needed depends on the deformity itself and where the pain is the worst. If the hammertoe is flexible and there is no pain on the ball of the foot, a tendon release may be all that is needed. Bone may also need to be removed from the joint to allow the toe to sit flat. If there is pain on the ball of the foot at the base of the toe there may be a need to cut the metatarsal head and shift the toe back to relieve pressure. After the toe is straight a pin is placed and will remain for six weeks.
What happens if I need surgery?
If non operative management fails and the patient continues to have pain or wound problems surgery may be indicated. Surgery for hammertoe is generally an outpatient surgery and you can go home the same day. Patients will be placed in a post op shoe and allowed to be weight bearing as tolerated. There will be a plastic toe guard to protect the pin from being moved or pulled. Sutures are removed in 10-14 days. Pins remain in place for six weeks and will then be pulled in office.
Potential complications from surgery include hammertoe recurrence. Recurrence rates are around 8%. Pins are left in toes for six weeks in order to help prevent recurrence. Patients will also sometimes complain of hover toe after surgery. To prevent this physical therapy is done to keep the toe stretched and massage to help prevent scar tissue formation.