Hammertoe

What is it?

A hammer toe is a deformity that causes your toe to bend or curl downward instead of pointing forward. Hammer or mallet toe is a foot deformity that occurs secondary to an imbalance in the muscles, tendons and ligaments that normally maintain the toe in proper alignment. This deformity can affect any toe on your foot, but most commonly affects the second or third toe. Although a hammer toe may be present at birth, it usually develops over time due to wearing ill-fitting shoes, such as tight, pointed heels or following trauma. In most cases, a hammer toe condition is treatable.

Your doctor may order x-rays to further evaluate the bones and joints of your feet and toes when properly diagnosing hammertoe.

What are the treatment options? Your doctor may recommend that you switch to different shoes that have more room in the toe box and that you were shoe inserts or pads. These can help to reposition your toe and relieve pressure and pain. In addition, your physician may trim callosities or corns from the deformed toes. Exercises such as picking up marbles or scrunching a towel up with your toes may also be recommended to stretch and strengthen the toe muscles.

If nonsurgical interventions do not work, your doctor may recommend surgery to release the tendon that is not allowing the toe to lie flat. While surgery will correct the hammertoe, it should be noted that your toe will not bend normally afterwards.

Risk Factors

Hammertoe has been linked to the following:

high heeled shoes or shoes that are too tight in the toe box
trauma such as stubbing or jamming the toe
abnormal balance of toe muscles

There is an increased risk of developing hammertoe for the following reasons:

age
being female
toe length - if your second toe is longer than your big toe
certain diseases such as arthritis or diabetes

Procedure Goals The goal of a hammertoe procedure is to straighten the involved toe or toes.

What to Expect

Before Procedure

Prior to surgery, your doctor will perform a physical exam, take X-Rays and determine if you are a candidate for surgery.

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants and a t-shirt for surgery.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

Most patients will be sent home a few hours after surgery. Your foot will be bandaged and you will most likely be given a surgical shoe to wear home that will protect your toe and help you walk after surgery.

Stiffness, swelling and discomfort are common after this procedure and can be easily managed with rest, ice, elevation and possibly with prescribed pain medication.

If you have any persistent burning, numbness or tingling in your toes, foot or ankle that is not alleviated with rest, ice and elevation, call your physician.

Full recovery can take one to three months and is largely dependent on which toe(s) were operated. Best results will come from adhering to your post-op instructions and include: keeping your foot elevated as much as possible for the first few days; icing for 20 minutes every hour; and avoiding prolonged standing and walking for at least one month.

After two to eight weeks you are able to discontinue wear of you postoperative shoe/boot. Your surgeon will direct you when it is appropriate to transition to normal foot wear.

Return to work will vary based on your job. Ask your physician for clearance to return to work. Return to physical activity is usually possible after four to eight weeks. Ask your physician for clearance to return to sports or other physical activities.

Your corrected toe will be straight and stiff following hammertoe correction and will not flex or bend like a normal toe.

Discharge Instructions

Diet

You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Ankle Care & Bathing

If applicable, use your crutches and follow the weight bearing precautions given to you by your physician.
Keep your ankle elevated above heart level as much as possible for the first five days, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing.

Cold Therapy

To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling.
To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
It is not necessary to use ice while sleeping.
We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
No driving while taking any narcotic pain medication! • The pain medication may cause some nausea so take it with food.
The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

Watch for temperature > 101.5F, persistent numbness and tingling in the foot, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

Formal rehabilitation after a hammertoe procedure is not often necessary. However, you may need to do range or motion exercises to restore normal mobility. Your surgeon will determine your need for formal therapy.