Hammertoe Surgery: Everything You Need to Know

Hammertoe surgery is a procedure to correct a deformity in the second, third, or fourth toe—a bend at the middle joint that makes the toe look like a claw or hammer. The surgery is performed to lessen pain and/or improve flexibility when the muscles in the toe can’t stretch and straighten.

Your doctor may suggest hammertoe surgery after more conservative measures have failed, including wearing roomier, more comfortable shoes or trying over-the-counter splints and pads. 

What Is Hammertoe Surgery?

This outpatient, scheduled surgery is performed to straighten the toe joint when it is stuck in a flexed position and causing pain, irritation, or sores. Severe cases of hammertoe may be treated with surgery in both adults and children.

Your surgeon may choose to use one or more surgical techniques, depending on your specific case and level of deformity. Possibilities include:

• Fusion: This is the most common surgical procedure for hammertoes. Both ends of the bone at the fixed joint are cut. A pin, or K-wire, is temporarily inserted to keep the toe straight; once the ends fuse, the pin is removed. A newer technique involves a rod or screw that is permanently implanted.
• Tendon transfer: This involves rerouting tendons from the bottom of the toe to the top to help it straighten.
• Joint resection: The end of the bone at the fixed joint is removed and pins are placed temporarily to keep the toe straight.

Although the surgery may involve more than one toe, you'll likely have surgery on just one foot at a time.

Bunion surgery can sometimes be done at the same time as hammertoe surgery. A bunion can cause hammertoe if the big toe puts pressure on the second toe over time.

Contraindications

If you have a flexible or minor case of hammertoe, your surgeon may suggest a less invasive procedure. This may include a tenotomy, which cuts the tendon rather than the bone to straighten the toe.

Your doctor may also suggest an alternative to hammertoe surgery if you have a health condition that increases the risk of the procedure, including an infection, poor circulation, or an uncontrolled medical condition.

Potential Risks

Complications specific to hammertoe surgery are small, but may include:

• Chance of recurrence
• Feeling “unstable” in the area of toe from the cutting of ligaments and tendons

Talk with your doctor about any potential risks specific to your case before undergoing surgery.

Purpose of Hammertoe Surgery

Hammertoe causes the toe to bend upward in the middle, which can irritate the end of the toe that’s pressing against the ground and cause the raised part to rub against your shoe.

Hammertoe surgery is typically done in severe cases with the goals of helping to straighten the toe and decrease associated pain.

Most cases of hammertoe are from wearing tight or high-heeled shoes that cause pressure against your toes over a long period of time. This pressure can cause the toes to be forced into a bent position. Over time, your toe muscles weaken and may be unable to straighten.

Some medical conditions can make you more likely to develop hammertoe. Rheumatoid arthritis can cause progressive damage in the foot's joints, making them unstable and leading to hammertoe deformity.

Chronic nerve damage from diabetes and muscle imbalance from stroke or spinal cord injuries can cause poor foot mechanics that lead to hammertoe. If you have a contributing medical condition, your doctor may work to treat it first before considering hammertoe surgery.

But before surgery is considered, your doctor will likely have you try conservative treatments to see if they offer adequate relief. These will focus on the symptoms, helping to stretch or make the toe more comfortable and may include:

• Wearing shoes that have lots of room around the toes (toe box should be about 1/2 inch longer than your longest toe)
• Exercises to help stretch and strengthen the muscles in the toes
• Over-the-counter pads, cushions, or straps to help cushion or straighten the toes

If these prove to be ineffective and you still have consistent pain or trouble wearing shoes, hammertoe surgery may be recommended to straighten the toe depending on its flexibility or level of stiffness.

Before scheduling surgery, your surgeon will do a physical exam and note whether your toe is rigid or can be stretched manually. Some X-rays may be ordered to evaluate your bones and joints.

Lab tests may be ordered to make sure that you're healthy enough for surgery, particularly if you're at risk for chronic health conditions. This can include blood work, such as a complete blood count (CBC), and an electrocardiogram (EKG) to check the condition of your heart.

You may also need clearance from your primary care provider or a specialist like your cardiologist before you can undergo surgery.

How to Prepare

During your pre-operative meeting with the surgeon, you’ll have a chance to ask questions about the procedure. That might include what the surgical plan entails and what to expect after recovery.

You’ll likely discuss the type of anesthesia that will be used, whether it is general anesthesia or a nerve block to make the foot go numb while it's being operated on.

Your surgeon may suggest a meeting with a physical therapist before surgery as well. In the weeks after surgery, you'll use assistive devices, like crutches or a walker, to keep your weight off your foot while you're healing. The physical therapist can help teach you how to use such devices before surgery.

They can also give you exercises to do before your procedure that can improve your balance and strength in your opposite leg; this can make moving around after surgery easier. The physical therapist can also give you advice after surgery for foot exercises to help you recover.

Location

Your surgery will likely be in a hospital or surgical center. As part of your preparation, make arrangements for someone to bring you home from surgery.

What to Wear

Wear loose, comfortable clothing to the hospital or surgery center. You’ll be asked to change into a hospital gown before the procedure. 

Make sure to bring a comfortable, no-slip shoe for the unaffected foot after surgery. After surgery, you won’t be able to wear a normal shoe on the operated foot; a special boot will be provided to you.

Food and Drink

If you’re having general anesthesia, you’ll be advised to stop eating and drinking after midnight on the day of your surgery so that your stomach is empty. Check with your surgeon for further recommendations.

Medications

Review your current medications with your doctor or anesthesiologist before the surgery. They may ask you to stop taking medications that may increase bleeding, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and supplements like fish oil and St. John’s wort.

What to Bring

On the day of surgery, you should plan to bring any paperwork, your insurance card, a driver’s license, and your pre-surgical test results if they were done at a different location than your surgery.

If your doctor suggests any assistive devices, such as a walker or crutches, make sure to bring those as well. If you don't already have them before surgery, you'll receive them at the hospital when you're ready to go home.

Pre-Op Lifestyle Changes

To decrease the risk of complications, talk with your doctor about quitting smoking before your surgery. Nicotine slows the flow of blood, which can increase the chance of a blot clot, healing problems, and infections after surgery.

You may also want to make some adjustments to your home before surgery. For example, moving your bed from a second to a first floor so you do not have to climb stairs as you heal.

You'll need to plan to take some time off of work after the surgery. Depending on your job—whether it's sedentary or one that requires you to be on your feet—this could last one to six weeks. Talk with your surgeon about how long you should make arrangements to be away from work.

You may also want to make arrangements for someone to help you with housework and child or pet care while you're recovering. Since it can take about six weeks to recover completely, you'll want to make sure you can stay off of your foot during that time as much as possible.

What to Expect on the Day of Surgery

On the day of surgery, your pre-surgical nurse or physician’s assistant will meet with you. They will review any notes on your case, perform a physical exam, and cleanse the area of the incision. You’ll likely then meet with the surgical team, which includes the surgeon, surgical nurses, and physician’s assistant.

During the Surgery

General anesthesia is either given through a breathing mask or intravenous (IV) line in your arm. Once you're asleep, the anesthesiologist may insert a breathing tube in your windpipe to protect your lungs during surgery. If you receive a nerve block instead, the surgeon will inject medicine to numb the area.

The procedure steps will vary depending on whether your hammertoe is flexible or fixed.

Flexible Hammertoe

Surgery for this condition may involve transferring the tendons from the bottom of the toe to the top to help straighten the joint. The surgeon makes incisions in both places. One of the two tendons on the bottom is then transferred and attached.

Fixed Hammertoe

If your hammertoe is stiff, your surgeon may remove the rigid joint by making an incision on the top of the toe and removing the end of the bone at the joint. The joint is held straight temporarily by pins.

Another option is a fusion. The surgeon cuts the ligaments and tendons as well as the ends of the bone at the joint. Typically, a K-wire is used to keep the bones joined together until the ends heal. In a newer procedure, rods and screws that don't have to be removed are implanted in the toe to keep it in a stable position.

Your surgeon will close up the incisions with stitches, which will be removed about two weeks after surgery. Your foot will be bandaged after surgery is completed.

After the Surgery

Hammertoe surgery is an outpatient procedure, so you can usually go home on the same day as surgery.

Hospitals and surgery centers may vary on discharge policies. In general, you may be able to leave when you are able to safely stand and walk with assistance, eat and drink without nausea, and urinate without any problems.

You'll be given a surgical shoe or boot to wear at home. For pain, your surgeon may suggest over-the-medicine such as Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen).

Recovery

Recovery usually takes about six weeks for most people depending on what your surgery entailed. If the procedure was done on your right foot, you may not be able to drive for a few weeks after the surgery.

You’ll have a bandage on your foot that will be changed at the surgeon’s office about two to four weeks after surgery. Stitches are usually removed two to three weeks after surgery. Pins may be taken out in three to four weeks as well.

Healing

You may be given a stiff-soled surgical shoe with an open toe to wear for about four weeks after surgery. After that time, your doctor may suggest wearing a wide, deep, soft shoe for up to six weeks.

When resting, try keeping your foot elevated at the level of your heart by using pillows underneath it for the first few weeks after surgery. You might also need crutches or a walker depending on how well you can walk.

Keep your bandages clean and dry. After your stitches are removed, your doctor will likely give you another bandage to wear for two to four weeks.

Follow your surgeon’s instructions for when you can start washing the area. While you have a bandage, you should take sponge baths or cover your foot with a plastic bag when bathing, making sure water can’t get into the bag.

Your surgeon may suggest exercises after surgery to help with your toe's flexibility. Follow the directions of your surgeon or physical therapist on what exercises to do and how to avoid injury.

If you have any discomfort, your doctor may suggest continuing taking over-the-counter pain medicines.

Long-Term Care

Since hammertoe may be caused by shoes that don’t fit properly, make sure to wear shoes that are comfortable and have lots of room in the area of the toe moving forward.

Avoid wearing tight shoes or high heels. Ask your doctor about exercises you can do to help increase your mobility and prevent a recurrence. 

Possible Future Surgeries

Hammertoe surgery is typically sucessful in about 80% to 90% of cases. About 5% to 10% of patients may have hammertoe again, but those cases may not be in the same joint or toe. Less than 5% of people may have a fixation device that becomes loose or painful and needs to be corrected.

If surgery is needed again, the same procedure may be repeated or your doctor may decide on a different surgery, depending on your condition. For example, if you had a tendon transfer, they may decide on a fusion procedure the next time.

A Word From Verywell

Hammertoe surgery may be an option if your hammertoe is painful or making it difficult to walk. For many people, it can successfully treat a serious case when other conservative treatments fail. It is possible that the condition can return, so ask your doctor about whether you might need another surgery in the future. They can help you determine whether hammertoe surgery is the best treatment for you.