Definition

A hammer toe is a toe that stays in a curled or flexed position.

This can occur in more than one toe.

This condition is caused by:

• Muscle imbalance
• Rheumatoid arthritis
• Shoes that do not fit well

Alternative Names

Flexion contracture of the toe

Description

Several kinds of surgery can repair hammer toe. Your bone or foot doctor will recommend the kind that will work best for you. Some of the surgeries include:

• Removing parts of bones in the toe
• Cutting or transplanting the tendons of the toes (tendons connect bone to muscle)
• Fusing the joint together to make the toe straight but no longer able to bend

After surgery, surgical pins or a wire (Kirschner, or K-wire) are used to hold the toe bones in place while your toe heals. You will be asked to use a different shoe to walk to allow your toes to heal. The pins will be removed in a few weeks.

Why the Procedure Is Performed

When hammer toe starts to develop, you may still be able to straighten your toe. Over time, your toe may get stuck in a bent position and you can no longer straighten it. When this happens, painful, hard corns (thick, callused skin) can build up on the top and bottom of your toe and rub against your shoe.

Hammer toe surgery is not done just to make your toe look better. Consider surgery if your hammer toe is stuck in a flexed position and is causing:

• Pain
• Irritation
• Sores that can lead to infection
• Problems finding shoes that fit
• Skin infections

Surgery may not be advised if:

• Treatment with paddings and strapping works
• You can still straighten your toe
• Changing to different shoe types can alleviate symptoms

Risks

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding
• Infection

Risks of hammer toe surgery are:

• Poor alignment of the toe
• Pain around your toe
• Injury to nerves that could cause numbness in your toe
• Scar from surgery that hurts when it is touched
• Stiffness in the toe or a toe that is too straight
• Shortening of the toe
• Loss of blood supply to the toe
• Changes in appearance of your toes

Before the Procedure

Always tell your health care provider and surgeon what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.

• You may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen, (Advil, Motrin), naproxen (Naprosyn, Aleve), and other medicines.
• Ask your surgeon which medicines you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your provider for help. Smoking can slow healing.
• Always let your surgeon know about any cold, flu, fever, or other illness you may have before your surgery.
• You may be asked not to drink or eat anything for 6 to 12 hours before surgery.

If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions before the surgery.

After the Procedure

Most people go home the same day they have hammer toe surgery. Your surgeon will tell you how to take care of yourself at home after surgery.

References

Chiodo CP, Price MD, Sangeorzan AP. Foot and ankle pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 52.

Montero DP, Shi GG. Hammer toe. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 88.

Murphy GA. Lesser toe abnormalities. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 84.

Myerson MS, Kadakia AR. Correction of less toe deformities. In: Myerson MS, Kadakia AR, eds. Reconstructive Foot and Ankle Surgery: Management of Complications. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 7.