Hammertoe is a common foot deformity where the toe bends abnormally at the middle joint, causing it to resemble a hammer or mallet shape. This condition often affects the second, third, or fourth toes and can lead to pain, corns, and difficulty wearing shoes. Correction is possible, with treatment depending on the severity and stage of the deformity. Management ranges from simple changes in footwear to surgical intervention.
Defining Flexible and Rigid Hammertoes
The treatment path for a hammertoe is determined by whether the deformity is classified as flexible or rigid. A flexible hammertoe is the earlier, milder stage where the bent joint can still be manually straightened.
If the condition is left unaddressed, it can progress to a rigid hammertoe. This occurs when soft tissues, such as tendons and ligaments, tighten and the joint structure changes, causing the toe to become fixed and immobile. The toe cannot be manually manipulated back into a straight position. Flexible hammertoes typically respond to conservative measures, while rigid deformities usually require surgery for correction.
Conservative Management Strategies
For a flexible hammertoe, conservative management aims to alleviate symptoms and halt progression. The most effective change is selecting footwear with a wide and deep toe box to give the toes ample space. Avoiding high heels and shoes that narrow or pinch the forefoot is advised, as these force the toes into bent positions.
Custom orthotics or supportive shoe inserts help redistribute pressure across the foot, taking strain off the affected toe joints. Padding placed over the bent joint reduces friction and prevents painful corns and calluses. Taping or splinting the toe can also be employed to gently immobilize the digit in a straighter position. Specific exercises and stretches may be recommended to help maintain toe mobility and muscle balance.
Invasive Correction Procedures
When conservative methods fail or the deformity has progressed to the rigid stage, surgical correction is necessary. The goal of these procedures is to realign the toe, relieve pain, and restore function. For a flexible hammertoe, the least invasive option is often a simple tenotomy, which involves a small incision to release the affected tendon and allow the toe to straighten.
For advanced or rigid deformities, bony procedures are required. These include joint resection (arthroplasty), which removes a small portion of the bone from the bent joint to shorten the toe and allow it to lie flat. Another technique is arthrodesis, or joint fusion, where damaged joint surfaces are removed and the bones are permanently joined together. This fusion creates a stable, straight toe structure, often using temporary pins or permanent implants. A tendon transfer may also be performed, rerouting a tendon to help pull the digit into proper alignment, a technique often used for flexible deformities.
Recovery and Long-Term Outlook
Following surgical correction, patients are typically sent home the same day with a specialized surgical shoe or boot to protect the foot. Immediate post-operative care focuses on managing swelling by elevating the foot and controlling pain with medication. Stitches are generally removed after about two weeks, and any temporary fixation wires are usually taken out within two to six weeks.
Most patients transition back into supportive, loose-fitting shoes around six to eight weeks after the procedure. Full recovery, including the resolution of swelling and a return to normal activities, often takes between six to twelve weeks, though it varies depending on the specific procedure performed. Surgical correction is successful in providing long-term pain relief and restoration in approximately 90% of cases, but there is a small risk of complications, including stiffness, nerve damage, or recurrence of the deformity.