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Hammertoe

Common in adults who will experience pain or irritation when wearing shoes, corns or calluses on the toe, a burning sensation and in more severe cases ulcerations.

Hammertoe

What is a hammer toe/ claw toe/ mallet toe?

There are different types of small toe deformities: claw toes, hammer toes, and mallet toes.

Claw toe: Involves an upward bending of the toe joint at the ball of the foot. The middle joint, and sometimes the end joint as well, the toe bends downward in a claw-like fashion, often digging into the sole of the foot. This can occur in any toes except the big toe.

Hammertoe: Toe is bent at the middle joint causing a curling of the toe. Most common in the second toe but can occur in any toes. Hammer toes are often present along with a bunion deformity.

Mallet toe: Similar to hammertoe except the joint involved is the last joint (DIPJ) instead of knuckle joint (MPJ), giving the toe a mallet-like appearance at the end of the toe.

The small toes are important in walking, especially when pushing off with the foot towards the next step. They share the pressure with the big toe and the ball of the foot. Toes become deformed when the pressures on the toe are stronger than their joints can resist. This may be because the joints are weak or the pressures strong, or both. The joints may be weak because they have been damaged by injury or arthritis. The muscles that control them may become unbalanced, so that one set pulls harder than others and causes the toe to bend. In some people the tissues in the lower part of the joint at the base of the toe (metatarso-phalangeal joint or MTPJ) become weak, allowing the base of the toe to drift upwards and unbalancing it.

The main pressures which cause toes to become deformed, come from shoes which press on the tip of the toe, either because the shoe is tight or because it has a high heel, which tends to force the toes into the tip of the shoe. The main problem with deformed toes is that they tend to rub on shoes, either on top of the PIPJ or at the tip or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw, and this may result in ulcers.

If the MTP joint is bent upwards, the toe may press down and cause pain in the ball of the foot (“Metatarsalgia”) Bent toes may rub on one another or on the big toe, especially in case of concurrent bunion deformity.

Causes

Poorly fitting shoes: usually wearing shoes that are too short.

High Arched foot:

Genetics / Bunions / Rheumatoid arthritis / Diabetes / Tendon imbalance:

Underlying neurological condition: such as Charcot-Marie tooth disease.

Hammertoe causes include a muscular imbalance between the tendons in the foot. This is known as the flexible hammertoe which is easy to treat. This usually requires minimally invasive tenotomy under local anesthesia.

Over time if left untreated the joints adapt to the positions and this becomes arthritic and may require bone surgery.

Conditions such as arthritis or diabetes can also contribute to the development of foot problems that include Hammertoe.

Pressure from a bunion of the big toe can also be a cause of Hammertoe so if you are feeling pain or have bunions it is always best to have them checked to avoid further complications.

Treatment

Conservative

Padding and taping between your toes and strapping them in place may help to stop pain caused by toes rubbing.

Orthoses can reduce excessive pressure from painful areas.

Shoes with wider and deeper toe areas can also help you get around more easily.

Regular visit to podiatrists to remove painful hard skin can help reduce pain in a short term.

Surgical

Surgical treatment is usually recommended when conservative treatments have failed. There are three different procedures depending on the problems with your toes.

  • Flexor Tenotomy
  • Arthroplasty
  • Arthrodesis

Your surgeon will discuss with you which of the following procedures your operation is likely to involve.

  • Releasing or lengthening tendons
  • Putting joints back into place
  • Straightening a toe by removing some bone
  • Stiffening one of the toe joints
  • Changing the shape of metatarsal bone to shorten or lift it away from the skin in the ball of the foot

Before & After Photos

Hammertoe Correction 2
Rigid Hammertoe Deformity 2nd & 3rd toes + Flexible Hammertoe Deformity 4th toe - PIPJ Arthrodesis 2nd & 3rd toes + Keyhole Tendon Rebalancing 4th toe

Appointment Information

Cost & Item Codes – Our fees are quoted on a case-by-case basis after your initial consultation with the surgeon as each patient presents differently and each surgery varies from patient to patient. Please book an initial consultation to discuss this further.

Scans – We recommend you have weight bearing x-rays prior to your appointment.

Telehealth – We may be able to offer an initial telehealth appointment if you live a distance away. Phone one of our friendly staff to see if this is possible for you. We may ask you to email some photos prior to your appointment. (1. from patient looking down at the front of their foot/feet 2. if someone can take a photo at floor level from behind of foot/feet)

Surgery Information

Do I need surgery? – Although your surgeon may recommend an operation to improve toe alignment and function of your foot and reduce pain, it is your decision if you go ahead with the operation or not.

Problems of the small toes do not get better without surgery. Conservative treatments will usually prevent them from getting rapidly worse. Your toes should be straighter, so your foot should fit more comfortably in a normal shoe. The skin on the toes can become inflamed and infected.

Duration – The procedure typically takes between 30 to 45 minutes and patients can usually return home the same day.

Anaesthesia – Surgery can be performed under local anaesthesia, or general anaesthesia, depending on the surgeon’s and the patient’s preferences.

Medications – Your surgeon or anaesthetist may give you antibiotics during the operation to reduce the risk of infection.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

Recovery Process

Patients must follow their surgeon’s instructions carefully during recovery to ensure proper healing and minimize the risk of complications.

The recovery process following small toe surgery varies depending on the type of surgery performed and the individual patient. In general, the following timelines can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. Minimal weight bearing with foot/feet elevated, getting up for essential things only like toilet breaks 5-10 minutes maximum per hour.

  • Avoid smoking
  • Take pain medication as instructed
  • Some blood ooze can be expected in the bandage.

The first few days: You will need to rest and elevate your foot as much as possible.

1-4 weeks: Do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen, or sore, you need to see your surgeon. Keep the foot dry. You may shower with a waterproof cover over your foot.

Tenotomy – no stitches required, toe bandage for 1 week. Patients can weight bear in surgical shoe as directed 1-2 weeks.

Arthroplasty – stitches removed week 2. Your wound needs to be kept dry until stitches are removed. Patients can weight bear in surgical shoe as directed 2-3 weeks. Transfer to comfortable wide shoe as directed 3-6 weeks. 

Arthrodesis – stitches removed week 2. Your wound needs to be kept dry until stitches are removed. Patients can weight bear in surgical shoe as directed 4 weeks. Transfer to comfortable wide shoe as directed 4-6 weeks.

Driving – Your surgeon will advise when you can start driving, usually 4-6 weeks after surgery.

Flying – You should not fly in the first week after surgery. Check with your surgeon on individual circumstances.

Return to Work – Tenotomy sedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 1 week.

Return to Work  Tenotomy active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 2-3 weeks.

Return to Work  Arthroplasty sedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 1-2 weeks.

Return to Work  Arthroplasty active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 3-6 weeks.

Return to Work  Arthrodesis sedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 1-2 weeks.

Return to Work  Arthrodesis active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 3-6 weeks.

Symptoms relieve with a straight toe once the wound heals. The swelling often takes up to six months to go down completely. You should always wear comfortable shoes that have enough space for your toes. Wearing shoes with high heels or pointed toes may cause more toe problems in the future.

Low impact exercise Tenotomy 1 week; Arthroplasty 2-4 weeks; Arthrodesis 4-6 weeks.

High impact exercise – Tenotomy 2-3 weeks; Arthroplasty 4-6 weeks; Arthrodesis 6-8 weeks.

Surgery

Surgery is advised if non-surgical treatment fails.

Minimally Invasive Repair Brisbane and Gold Coast

Depending on the extent of the stiffness presented in the toe and flexibility it may be possible to perform a minimally invasive surgery known as a flexor tenotomy which releases the tendon. This simple procedure performed under a local anaesthesia releases the tight tendon with only a simple stab incision through the skin and no stitches are required. Our minimally invasive Hammertoe repair does not require the fusion of any joints which previously meant the loss of mobility.

Patients experiencing established stiffness or complete rigidity in the toe undergo a simple hospital-based surgery known as an ‘arthroplasty’ or an ‘arthrodesis’. The surgery releases both the tight tendon and realigns the mal-positioned bones.

Immediate weightbearing is allowed after surgery.

Dr Kim only uses internal implant that does not require removal later on. The internal implant provides compression and stability so your recovery is faster and there is also lower risk of infections.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Podiatric Surgeon Dr Kim is the leading surgeon for Foot Surgery in Brisbane and Gold Coast. Contact him today to see if you are a good candidate for minimally invasive Hammertoe keyhole surgery

No referral needed

Contact Us

A GP referral is welcome however it is not essential for your appointment

About

Dr Ji Soo Kim (Specialist Podiatric Surgeon) BPodM, DClinPod, FFPM RCPS(Glasg)

Book Appointment

Dr Kim has two offices, one located in Kelvin Grove, Brisbane. The other is in Southport, Gold Coast.

Please call 1300 522 096

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