Last week we discussed 3 types of digital deformities: Hammer toes, Mallet toes and Claw toes. They are very similar and treatment for each is much the same, but they can be distinguished from one another by the involved joints. The most common complaint with these deformities relates to areas of increased pressure and formation of a corn with resultant pain. Eliminating pressures on the top of the toe is usually the goal of treatment and there are various ways in which to have success. Conservative treatments can include periodic trimming down of the corns, padding of the toes and strapping the affected digit to a “neighboring” toe in attempt to straighten out the deformity. Wearing shoes with a roomier toe box can also be effective making hammer toes easier to manage and live with. When conservative treatment fails or is not an option, surgical options are available.
Much the same as surgical correction for bunion deformities, hammer toe surgical correction involves a choice between a soft tissue, boney or fusion procedure. The selection of one procedure over the other is a decision that your Podiatrist will make based on their clinical judgment and your level of discomfort. Each procedure aims to bring the joints involved in the deformity back into correct alignment resulting in straightening of the toe and reduction of pain.
Soft Tissue Procedure: A soft tissue procedure used for surgical correction of a hammer toe attempts to release the capsule surrounding the joint as well as release the tendons entering the toe so that the bones are free to straighten out into their correct position. Often times the digit contracts due to muscular imbalance, thus releasing the tendons of the involved digit essentially eliminates the imbalance. It is common practice during these procedures to have the corn, located on the top of the toe, removed decreasing pressure and reducing pain. Soft tissue procedures are used alone in the presence of mild deformity where the patient complains of pain without significant boney involvement. However, when a more aggressive boney or fusion procedure is used for surgical correction, as described below, a soft tissue procedure is also performed.
Bone Procedure: A boney procedure is one that requires cutting the bone and eliminating a portion of the bone involved in the deformity. Depending on the joint affected (whether you’re dealing with a hammer, mallet or claw toe), one or two of the three bones within the toe will be cut and a portion of that bone removed. In the classic hammer toe where the middle joint is affected, a portion of the bone closest to the body of the foot will be removed, decompressing the joint and allowing the toe to straighten. A pin will be placed into the toe for 4 to 6 weeks holding the corrected position until the surrounding soft tissues have healed. Keep in mind that because a portion of the bone within the toe is being removed, the toe will end up a little shorter than it started out.
Fusion Procedure: A fusion procedure is used when there are multiple joints (remember there are 3 joints within each toe) involved in the deformity and when the hammer toe is considered to be rigid, or non-flexible. A fusion removes any material within the joint space that is destroyed and allows the bones within the toe to be straightened out and brought together by pin fixation over 6 to 8 weeks. Fusions eliminate motion at the joints within the toe, so it is important to remember that after the procedure you will no longer have a contracted digit, but you will also no longer be able to bend the toe as you were prior to the surgery.
The risks and benefits of surgery must be weighed and discussed with your Podiatrist prior to consenting for a procedure, and it’s always wise to attempt treating your hammer toe conservatively first. If you decide to move forward with surgical intervention your period of recovery will range anywhere from 2 to 8 weeks with the ultimate goal being reduction of pain and straightening of the toe to prevent excessive pressures.
