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Hammertoe syndrome is a general term used to describe symptoms and joint changes involving the toes. Hammertoes most frequently involve the second toe, however, multiple toes can be involved.

Two types of hammertoe exist:

  • Flexible hammertoes are in the developmental stage and the affected toes are still moveable at the joint.
  • Rigid hammertoes are more serious. The tendons tighten and the joints become misaligned and immobile.

What causes the pain?

Hammertoes are caused by an abnormal muscle balance in the toes, which leads to increased pressures on the toe tendon and joints. Heredity, trauma, arthritis, and wearing tight shoes can all lead to hammer toe.

Symptoms of hammertoe include:

  • Pain at the top of the bent toe.
  • Corns at the top of the joint.
  • Redness and swelling at the joint contracture.
  • Restricted or painful motion of the toe joint.
  • Pain in the ball of the foot at the base of the affected toe.

How is this treated?

Treatments include the following:

  • Padding the hammertoe to minimize pressure and taping the toes to change the muscle imbalance.
  • Alleviating pain through the use of anti-inflammatory drugs and cortisone injections.
  • Wearing custom shoe inserts to control foot function.
  • Surgery.

Surgery is recommended when you have severe pain in the toe that hinders your daily activities and non-surgical remedies have not helped or if you have a severely deformed foot. For less severe deformities, the surgeon removes the bony prominence on the toe and aligns the toe joint. Other surgical procedures include releasing a tendon that is too short, transferring a tendon to another location, and inserting a steel pin to correct the toe’s position.

Surgery for hammertoe aims to alleviate pain and enable the patient to resume regular activity wearing normal shoes. Although surgery helps the foot look more normal, appearance is not a primary goal.

What are the risks of treatment?

Risks include nerve injury, infection, bleeding, and stiffness.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Refrain from eating or drinking anything after midnight the night before surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin.
  • Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

The goal of surgery is to realign the toe and improve function. Corrective procedures may include lengthening tight tendons and ligaments, transferring a tendon to another place, removing portions of the bone, or inserting a steel pin to correct the position of the toe. Surgery is typically performed under local anesthesia with sedation, but complex procedures may require general anesthesia.

What happens after surgery?

The foot is bandaged and a protective surgical shoe is worn to allow weight-bearing movement after surgery. After surgery, there may be stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk moderate distances while the toe heals, and you should keep your foot elevated as much as possible.

If you experience persistent numbness, tingling, or burning sensations in your foot or ankle, it may be due to a cast or surgical dressing that is too tight. Elevate your foot, and if this does not resolve the problem, call your doctor.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

Healing requires three to six weeks.

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