19 Oct Everything You Need To Know About Hammer Toe Surgery
The deformity of hammer toe is the most common amongst deformities of the lesser toes. Generally speaking, the essence of the problem is the chronic, sustained imbalance between flexion and extension forces of the lesser toes during voluntary and involuntary movements. There is a strong association between the incidence of hammertoe deformity and the presence of a second foot’s ray that is longer than the first. It is known to be more common in women and to increase in frequency with advancing age.
The lesser toes are composed of three joints; these are the metatarsophalangeal joint ‘MTP’, the proximal interphalangeal joint ‘PIP’, and the distal interphalangeal joint ‘DIP’. Hammertoe deformity primarily involves flexion deformity of the PIP joint of the toe, with hyperextension of the MTP and DIP joints. Several etiologies may contribute to the development of a hammer toe. Wearing tight shoes or high heels that crowd the toes and prevent them from flattening may cause flexion of the PIP joint to accommodate the shoe. Eventually, the MTP joint hyperextends and may even progress to dorsal subluxation or dislocation.
If you have symptomatic hammertoe, you will typically complain of pain over the dorsal aspect of the proximal interphalangeal (PIP) joint of the affected toe. A callus ‘new bone formation’ may be present over the dorsal surface of the PIP joint, or over the plantar surface of the metatarsal head. Although radiographic evaluation of hammertoe is not necessary for the diagnosis, it can help rule out alternative diagnoses and may aid in surgical planning. Two options are there for treating hammertoe deformity. Conservative therapy may be considered for a flexible deformity, while a surgical repair is mandatory for a fixed hammer toe. Strapping of the toe with either tape or a hammertoe sling is helpful for flexible deformities; however, this modality demands the use of shoe wear that will accommodate the straps or slings.
Various techniques can be considered for hammer toe repair. MTP arthroplasty, for instance, involves resection of 2 mm of the metatarsal head articular surface through a longitudinal incision just over the joint and pinning of the toe across the MTP joint using K-wires which will be removed later. PIP joint arthrodesis, which is also called fusion, has been described and is currently performed regularly. A pin or wire is used to assist with healing. Another simple procedure is tendon transfer where the insertion of the tendon is moved from the button of the toe bone to the top, which promotes straightening of the PIP joint. Patients with severe stiffness may undergo basal phalangectomy. In this procedure, a part measures about 8 mm of the bone on the bottom of the toe is removed.
Hammertoe surgery recovery time is of crucial importance for patients who underwent the operation. Recovery normally takes a few weeks, and it depends on the type of surgery that was done. Weight-bearing and walking are not permitted while the fixation pin crosses the MTP joint. Stitches are usually removed two to three weeks after surgery. If pins were placed, they will be taken out within a few weeks. After the fixation pin is removed, you may be given a special shoe to wear to help with walking. Swelling after surgery is normal and may take up to one year to resolve.