• Hammer Toe Correction

    Definition

    A hammer toe correction is done to correct a foot deformity called a hammer toe .
    Hammer toe
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    Reasons for Procedure

    Hammer toe occurs when there is a shortening of the tendon that controls toe movement. This causes the middle joint of the toe to be bent upward and the outer joint downwards. The misshapen toe resembles a hammer. A hammertoe correction is considered when:
    • Other treatments have failed to bring about results.
    • The malformed toe has assumed an awkward position and is causing pain.
    • The deformity makes walking difficult.
    • The position of the toe causes breakdown of skin. This can increase the risk of developing a bone infection.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have the correction, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Excessive swelling, although the toe will normally be swollen for 4-8 weeks following surgery
    • Anesthesia-related problems
    • Recurrence of hammer toe
    • Nerve or blood vessel injury to the toe
    Factors that may increase the risk of complications include:

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • X-rays of joint
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    The day of the procedure:
    • Arrange for a ride to and from the procedure.
    • Arrange for help at home after the procedure.
    • Wear comfortable clothing that is easy to remove.

    Anesthesia

    Local anesthesia is often used. It will numb the area. Spinal anesthesia may also be used. This anesthesia will make your lower body numb.

    Description of the Procedure

    Several surgical options are available for hammer toe correction. Some corrections can be made with changes to soft tissue (eg, tendons); others need to be made to the bone.
    Soft Tissue
    This is usually best in patients under 30, with limited toe deformity. A cut is made in the skin and the tendon is released. Sometimes it is reattached to a different area of the bone. The changes in soft tissue will allow the toe to relax and eliminate the deformity.
    Bone
    Two common methods of hammer toe correction on the bones themselves are joint arthroplasty and joint fusion. The type of procedure used depends on how bad the deformity is. A combination of procedures may be needed. In both cases, a cut in the skin is made over the toe joint.
    During an arthroplasty, part of the bones on both sides of the middle toe joint may be removed. This will allow the toe to uncurl.
    During a fusion, the ends of the toe bones are removed. The bones are then repositioned. The repositioning is usually held together with a pin placed within the bone. The pin may be removed after 3-4 weeks. Other changes to the anatomy of the foot due to the hammer toe may also be corrected at this time.
    In any method, the doctor may close the incision with stitches. Dressings will be applied to hold the toe(s) in proper position.

    How Long Will It Take?

    This depends on the procedure and the number of toes corrected.

    Will It Hurt?

    Anesthesia prevents pain during the surgery. Your doctor will give you medicine to manage pain after the surgery.

    Post-procedure Care

    • During the first couple of days, keep your foot elevated most of the time.
    • Limit standing and walking, and stay off your foot as much as possible.
    • Use crutches or wear a special open-toed, wooden-soled shoe, as directed by your doctor .
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    The corrected toe may be slightly longer or shorter than before surgery. The toe will not move as much as a normal toe. Expect some swelling and redness, which may persist for several months. Your dressing may need to be adjusted as swelling decreases. If it appears that the deformity may recur, your doctor may choose to continue with dressings for another 2-4 weeks.
    Select shoes with plenty of space for your toes. Poorly fitting shoes contribute to hammer toe development.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Pain that you cannot control with the medicines you have been given
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/tabs/Index.aspx/

    CANADIAN RESOURCES

    Calgary Foot Clinic http://www.foottalk.com/

    Nurses Entrepreneurial Foot Care Association of Canada http://www.nefca.ca/news.php

    Podiatrists in Canada http://www.podiatrycanada.org/

    References

    American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org .

    Campbell's Operative Orthopaedics. 9th ed. Mosby-Year Book; 1998.

    Murphy GA. Campbell's Operative Orthopaedics. 10th ed. Philadelphia; Mosby, Inc; 2003.

    6/2/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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