Understanding Hammertoe Surgery: A Guide for Patients
Hammertoe is a condition that causes one or more of the smaller toes to bend down at the middle joint, creating a shape that looks like a hammer. This can cause pain, difficulty finding comfortable shoes, and the development of calluses. When conservative treatments like shoe adjustments or padding don’t work, surgery may be needed to correct the problem.
What Happens During Hammertoe Surgery?
When surgery is necessary for a hammertoe, the main goal is to straighten the bent toe and relieve the pain. The most common surgical technique for a fixed hammertoe (where the toe is stuck in a bent position and can’t straighten out) is called PIP joint resection arthroplasty or fusion. Here’s how the surgery works:
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Positioning the Patient: The patient is made comfortable on their back (lying down) under anesthesia, either general (fully asleep) or a regional block (numbing the area).
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Making the Incision: The surgeon makes a small cut on the top of the toe, right over the bent joint (called the PIP joint).
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Exposing the Joint: The surgeon removes the soft tissue (skin, tendons) to get to the toe joint. They might also remove any thickened skin (calluses) that can form over time.
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Releasing the Ligaments: The surgeon cuts the ligaments and tissues around the joint to free up the area and make it easier to realign the toe.
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Resecting the Joint Surfaces: The top and bottom parts of the joint are carefully removed using special tools. This helps to straighten the toe.
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Aligning the Toe: The toe is then positioned straight, and a small metal wire (called a K-wire) is inserted to hold it in place while it heals. This wire stays in the toe for several weeks.
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Closing the Incision: The incision is stitched up, and the toe is wrapped in a soft dressing to protect it during recovery.
What Happens After Surgery?
After the surgery, patients are usually told to wear a special shoe or boot to protect the toe as it heals. Most people can begin walking gently on their heel within a few days. Regular follow-up appointments are needed to check on the healing process.
The K-wire is typically removed after 3 to 6 weeks. This helps keep the toe in the correct position while it heals. Patients will also have stitches removed around the same time.
Results: What Can You Expect?
For most people, hammertoe surgery is very successful. Studies show that about 92% of patients experience pain relief after surgery. Also, 84% of patients are satisfied with the final results, reporting that their toe looks and feels much better. However, like with any surgery, there can be some risks, including:
- Infections around the surgical site (but these are rare and can usually be treated easily)
- Recurrent deformities where the toe may start to bend again (this can sometimes be fixed with minor procedures)
- Numbness in the toe after surgery (this might go away with time)
Complications to Watch For
While serious problems are rare, some people may experience issues like misalignment of the toe, or it might bend again (a condition called recurrent deformity). If this happens, the problem can usually be fixed with additional surgery, like tendon release or small adjustments.
Other Fixation Options
In the past, K-wires were the go-to solution for holding the toe in place during healing. However, newer methods using permanent implants like screws or special memory metal devices are becoming more common. These devices might provide even better results, especially for patients who need additional surgeries due to recurring problems.
Final Thoughts
Overall, surgery for hammertoe is a highly effective treatment for people whose condition does not improve with nonsurgical methods. Most patients experience significant pain relief and improved toe alignment. The procedure is safe with a low risk of complications, and most people are very happy with the results. If you are considering surgery, it’s essential to discuss all the options with your surgeon to choose the best treatment for your specific needs.
