Hammertoes

I recently had the privilege to give a presentation about a hammertoe implant to a group of foot & ankle surgeons. While preparing for it, I thought about how different surgery is now versus 10-15 years ago. I hear on a regular basis from my patients that they donʼt want to have their hammertoes fixed because they heard from someone how awful the recovery after surgery is. Normally I find out the person had wires that stuck out of the ends of their toes to hold them in place after the surgery. While this is still an acceptable practice, we have many more methods of fixation available to use now in place of those dreaded wires.

There are 3 types of hammertoes: hammertoes, mallet toes and claw toes. Which one you have depends on which joint in the toe is bent. The correction is very similar for all of these and we generally just call all of them hammertoes to make things less confusing. Hammertoes can be painful and will often become more bent and less flexible over time. They often cause pain or difficulty wearing closed toed shoes. In the worst cases, an ulcer will form over the bent joint from the skin thinning and then rubbing on a shoe. Many people have pain on the end of the toe instead of over the bent joint. This is because they are walking on the end of the toe instead of the bottom of the toe. Over time this can lead to ulcers and thickening of the toenail that can be mistaken for nail fungus. This nail change can be permanent if the nail bed becomes damaged.

Hammertoes can be caused by wearing poorly fitting shoes for many years or sustaining an injury to your toe. Most of the time however, they are the result of the biomechanics of the person's foot making them prone to developing hammertoes. Oftentimes if you have hammertoes, you can find a close relative with hammertoes. There is a high likelihood you will pass them on to your kids as well.

 

Hammertoes can be surgically corrected by either removing part of the joint to allow the toe to straighten back out, or by fusing the joint in a straightened position. The recovery from the first procedure is usually shorter but there is a risk of the hammertoe recurring. I fixate my hammertoe fusions using an implant that is buried within the bone of the toe and does not need to be removed unless there is a complication of some kind. Having to remove the implant is a very rare occurrence. There are many types of hammertoe implants available for surgeons to use. Surgeons choose which implant to use based on many factors. With an implant, you no longer have to worry about bending or breaking the wire if you accidentally stub your toe on a bed post, or catching a wire on your bed sheets. You can also change your dressing more easily and shower sooner. In most cases patients are able to walk the same day as their surgery while wearing a surgical shoe or walking boot.

Hammertoe implants will continue to advance, but there is no longer any reason to put up with the pain from your hammertoe because of fear of the discomfort from old fixation techniques.

Author
Dr Katie Evans Dr Katie Evans writes a monthly column in the Hometown Focus. The articles cover a variety of issues concerning the foot and ankle. If you have any recommendations for future articles, email them to rangefootandankle@gmail.com.

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