What is a hammertoe?
Hammertoes refer to a condition in which the toe is bent or crooked at one of the three joint levels. This can occur from a variety of reasons, and risk factors including family history, bunions, injury, and foot posture can all contribute to the development of a hammertoe. In children, hammertoes are often flexible and are referred to as 'curly toes'. They may even be present from birth in infants with a family history of the condition. As the bones of the foot develop and grow, deformities which were once flexible tend to become stiffer and eventually permanently rigid due to malposition and adaption of the bones and small joints. Adults with hammmertoes often experience a variety of problems such as rubbing, blistering on pressure areas of their toes, as well as corns, calluses and even ulceration in patients suffering from diabetes.
Treatment for hammertoes
Treatment of hammertoes may occur is advisable because the condition is progressive and the longer is left the more difficult it is to correct. Patients who are unable to undergo surgery due to poor health may benefit from pressure-relief devices such as silicone toe props to help take pressure off prominent bony areas. Routine podiatric debridement of painful corns and calluses can also be beneficial for these individuals. There are a range of surgical treatment options available to treat hammertoes, and the nature of the procedure required is largely based on the flexibility or stiffness present in the toe. In flexible deformities, where it possible to straighten the toe manually, a procedure known as a flexor tenotomy is often performed. This is an office-based procedure performed under a local anaesthetic in which the tight tendon is released by making a stab incision through the skin, and does not require any stitches. In patients where there is established stiffness or complete rigidity in the toe, hospital-based surgery is performed to address both the tight tendon, and realign the malpositioned bones. This is called either an 'arthroplasty' or an 'arthrodesis'.
Minimally invasive hammertoe repair
The technique we offer for hammertoe correction in patients with established stiffness or rigidity has several benefits over traditional orthopaedic approaches which generally require an external wire or pin to be used. Our minimally invasive hammertoe repair does not require any pins or exposed wires to be left in place after surgery, and allows for correction of the deformity by using a small sterile peak implant that is inserted and remains in the toe permanently. Unlike k-wires, the 'HammerFix' system offers stability and compression across the surgery site, allowing the bone to heal quickly and avoiding the risks of external infection or displacement developing from a wire.
The procedure only requires a small 1-2cm incision to be made over the toe, and causes minimal disruption to the soft-tissues and tendons. Patients are able to weightbear immediately after the procedure that generally takes place as a day surgery and takes approximately 20 minutes to perform.
Recovery after Minimally Invasive Hammertoe Repair
A typical patient journey after minimally invasive hammertoe surgery at our practice is documented below for reference. Please note that these milestones are taken as an average and some individuals may take longer to recovery from surgery.
1st post-op day to 1 week - Dressing and post-op sandal in place. Rest and elevate foot. Restrict activities to home only.
1 week to 2 weeks - Dressing changed at 1 week. Return to work OK if office based. Driving short distances OK.
2 weeks - Stitches removed. Transition back into sneakers. Apply compressive bandage and commence range of motion exercises. Upper body exercise only.
4 weeks - Progress review with surgeon. Bone usually 50% consolidated. Continue compression. Low impact exercise OK.
8 weeks - Progress review with surgeon. Bone usually 75-100% consolidated. Higher impact exercises OK. Continue compression. Return to wedged shoes/small heel OK.
12 weeks - Progress review with surgeon. Bone usually 100% consolidated. Activities generally unrestricted. Minimal swelling at this time usually.
Case Patient 1: Before and after MIS Hammertoe Repair
This patient had longstanding clawing of toes 2 and 3 both feet and was experiencing discomfort from pressure on the tips of her toes as well as rubbing of her knuckles in shoes. This patient had their procedure performed under local anaesthesia with minimal pain after surgery and was able to return to normal living activities within two days and commenced exercise at 2 weeks.
Case Patient 2: Before and after MIS Hammertoe Repair
Believe it or not, this patient had been turned down by several other foot surgeons and offered amputation of her toe as the only solution prior to visiting our clinic! She had suffered with a chronically dislocated 2nd toe which had been present for close to 20 years, making it almost impossible to wear an enclosed shoe. Using our minimally invasive hammertoe repair technique, we were able to successfully correct this lady's toe alignment without the need for any pins or other fancy implants. She is very pleased with her result from surgery which will enable her to wear enclosed shoes again, pain free.
Case Patient 3: Before and after Hammertoe Repair with Plantar Plate Repair
This patient had longstanding hammertoe deformities of her 2nd, 3rd and 4th toes associated with rupture of the plantar plates. As you will note from the photos, her toes were not only hammered, but significantly dislocated at the base joint (metatarsophalangeal joints) also. This patient underwent repair of her hammertoes via digital arthrodesis using an intra-medullary implant known as the Hammerfix system, and a dorsal approach was used also to provide primary repair of the plantar plates. Post-operatively, the toes must be strapped into a straight position for approximately 4 weeks to enable sufficient healing of the repaired ligaments, however ambulation in a post-operative sandal is permitted immediately following surgery.
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This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.