Hammertoe Surgery: What You Need to Know
Milwaukee Surgical Podiatrists & Orthopedic Surgeon Relieve Hammertoe Pain
Hammertoe surgery may be the best option for patients who are still in pain after trying non-invasive hammertoe treatments.
Patients with hammertoes often have other toe problems, such as bunions or corns. Our surgical podiatrists are highly experienced in both surgical and non-operative treatments for all types of toe pain, and will design an effective treatment plan for the overall health of your feet and toes.
- Types of hammertoe surgery
- Mallet toe surgery
- Is hammertoe surgery covered by insurance & Medicare?
- Hammertoe surgery recovery & after care
- Exercises after hammertoe surgery
- When can you drive after hammertoe surgery?
- Walking after hammertoe surgery
- Can you bend your toe after hammertoe surgery?
- Hammertoe surgery complications
- Hammertoe surgery pain
- Cost of hammertoe surgery
- Can hammer toes be corrected without surgery?
Hammertoes are caused by an imbalance in the muscle with the tendons on the top and bottom of the toe. Hammertoe surgery corrects the imbalance so the toe can straighten.
Hammertoe surgery is typically an outpatient procedure. It can be done with local anesthesia with or without sedation, or under full anesthesia. Hammertoe surgery is commonly referred to as toe straightening surgery, toe shortening surgery or toe fusion surgery - they're all referring to the same set of procedures. It's also possible to undergo hammertoe and bunion surgery at the same time.
Surgery for flexible hammertoes
Procedures to correct mild (still flexible) hammer toe deformities are usually the least invasive hammertoe surgery.
If the toe is still flexible, a tendon transfer from the bottom to the top of the toe can help straighten the bent joint. The joint is preserved and you’ll probably be able to bend your toe after the surgery.
Contact our caring podiatrists to discuss the best treatment for your hammertoes.
Tendon transfer for hammertoe correction involves rerouting the FDL tendon so it goes along the top of your toe instead of underneath.
This procedure is also called:
- Flexor digitorum longus (FDL) tendon transfer
- Flexor tendon tenodesis (tenodesis means transposition)
- Flexor-to-extensor tendon transfer
In its new position, the tendon acts as a corrective force on the abnormally bent toe and helps it find proper alignment.
Many hammer toe deformities including crossover are associated with abnormal biomechanics of the flexor and extensor tendons. A tendon transfer procedure balances the “pull” on your toe to prevent progression and recurrence of the deformity.
Tendon release is a surgical procedure used to relieve contracted muscles. The muscle-tendon can become shortened over time from wearing improper footwear, from an injury, or from improper development of the foot.
Tendon release for hammer toe is also called:
- Flexor tenotomy
- Tendon lengthening
- ‘Toe tendon release surgery’
Tendon release allows a greater range of movement and can treat pain, deformity and other issues associated with hammer toe.
During a tenotomy, the tendon may be cut entirely or just partway. In some cases the tendon is cut lengthwise and the two sections rejoined to form one longer tendon. Tendon release is usually a last resort if other more conservative treatments have failed, or if the severity of the deformity indicates another treatment is unlikely to be effective.
Surgery for rigid hammertoes
Surgical options for stiff, inflexible hammertoes include fusion (bone mending) or joint resection (arthroplasty).
Arthroplasty aka joint resection
Joint resection means removing one of the ends of the bone at the small joint where the toe is bent (not at the joint where the toe meets the foot).
Hammertoe surgery relieves painfully curled toes so you can enjoy your favorite activities again.
With fusion, both ends of the bone at the hammertoe joint are cut and as it heals they fuse together.
In both joint resection and fusion, tendons and ligaments are cut to allow the toe to straighten, and pins or a screw may be used to keep the bones steady during healing. After recovery, you’ll be able to bend your toe where it meets the foot, but not at the little joint.
In very rare cases, removing the deformed toe through the MTP joint (where the toe meets the foot) may be necessary when a patient is experiencing severe pain and all other treatment options have failed.
Amputation permanently alters the foot and can affect balance and walking. Yet in cases where the pain is caused only by a hammer toe and nothing else has worked, toe amputation can provide pain relief and result in patient satisfaction1.
What type of anesthesia is used for hammer toe surgery?
In many cases hammer toe surgery can be done as an outpatient procedure using a local anesthetic. This can make your recovery time shorter and easier.
Hammer toe surgery can also be performed under general anesthesia if you have a phobia of knives or needles or feel squeamish about the procedure. General anesthesia has rare complications and you may not be allowed to eat beforehand.
Discuss the risks and benefits of both types of anesthesia with your doctor. A third option is local anesthesia and an IV drug to help you feel more relaxed during the procedure.
Hammer toe, claw toe and mallet toe affect the feet and toes in slightly different ways, and are all deformities caused by underlying imbalance in the muscles, tendons and ligaments. Surgical and non-surgical treatment options for all three deformities are similar and all involve straightening an abnormally bent toe joint. (Related: Understand the difference between hammer, claw, and mallet toe)
Mallet toe surgery may be needed if conservative treatments for mallet toe pain have failed. Surgical repair of mallet toe deformity typically involves tendon release so the affected toes can lie flat. For some patients, bone from the end of the toe joint may need to be removed or fused.
If the toes are severely curled, surgical hardware (pins or screws) may be used to fuse and straighten the toes. If pins are used, they’ll need to be removed a few weeks after the surgery, but screws can stay in place.
Recovery time and after care for mallet toe surgery (or claw toe surgery) is similar to post-hammer toe surgery recovery and varies based on the patient’s overall health.
Is hammertoe surgery worth it?
Hammertoe surgery is generally very successful. In our experience, 90% of patients have significant reduction in pain and would recommend the procedure to others.
Your exact recovery time will depend on the type of hammertoe surgery and your overall health, but in general a full recovery after hammertoe surgery takes about six weeks.
In any case, you’ll need to avoid putting weight on your foot at first, and should try to keep it elevated for the first two weeks to relieve pressure. Your doctor may recommend a special shoe or crutches for the recovery period.
Hammer toe surgery aftercare
Whether you had local or general anesthesia, you’ll need someone to drive you home after hammer toe surgery.
After surgery, you’ll likely feel some pain in the toe, and you should avoid putting weight on your foot while it heals.
Try to keep your foot elevated for the first two weeks to relieve pressure. Most patients have some swelling after surgery, which may last for up to a year.
Walking will likely be difficult and painful at first, so your doctor may recommend a special shoe, cane or crutches for the recovery period. You may also be unable to drive for a few weeks, depending on which foot was operated on.
A few weeks after your surgery, the stitches and/or pins and screws can be removed.
Following the instructions of your surgeon, exercises to improve muscle strength in the toes and feet can help with healing. Keeping the muscles strong and balanced can also help prevent recurrence.
If you’ve had a hammer toe deformity once you’re at risk of developing it again. Follow your doctor’s recommendations for protecting the toe joint and preventing hammertoe from recurring.
Getting your feet back in shape after hammertoe surgery takes dedicated effort and patience, and can make a huge difference in your overall recovery.
Rehabilitative exercises are especially important after surgery to correct deformities, as your feet, ankles, and the rest of your body have likely learned habits to compensate for the chronic pain prior to surgery. It’s also a good idea to get rid of old footwear from your pre-surgery time as shoes can retain the same compensation patterns.
Exercise improves circulation & is an important part of recovery and healing.
It’s important to get approval from your foot surgeon before you begin any type of foot exercise after hammer toe surgery. Ideally, your surgeon will also provide a referral to a physical therapist along with basic “Dos & Donts” for your exercise regimen.
- It’s best to begin with non-weight bearing exercises
- Pilates, yoga and other forms of whole-body exercise are a good way to work out without putting weight on your feet (and have the added benefit of improving posture, alignment and balance from head to toe)
- Swimming or water jogging can allow for low-impact aerobic exercise while your toes are in recovery mode
- In addition to resuming regular exercise, it’s important to include foot fitness moves targeting the muscles and connective tissue in your feet, ankles, and toes
- Foot exercises designed to improve strength, flexibility, range of motion and balance in the feet can provide benefits with as little as 5-10 minutes of practice, 2-3 times per week
Remember no two bodies are alike – before beginning any type of exercise for your feet or the rest of you, talk to your surgeon and a physical therapist experienced with hammertoe surgery recovery.
Recommended types of foot exercises may include:
- Stretching exercises for your toes, feet and calves
- Strengthening exercises designed to improve muscle imbalances
- Scrunching a towel with your toes
- Using exercise bands
- Standing on an uneven surface
- Toe raises
- Exercises to correct gait and alignment
- Uphill walking
It depends on the specific surgical intervention used to correct the deformity.
You’ll be able to bend the toe at the MTP joint (where the toe joins the foot). If permanent screws or bone fusion were involved, you won’t be able to bend the middle toe joint.
Results may vary based on your overall health and the type of surgery performed, but in general it’ll be 4 to 6 weeks before you can drive again.
In general, you can start putting some weight on your foot again around 4 weeks after surgery. Until then, you’ll need to use a scooter, crutches or a wheelchair (in limited amounts as instructed by your doctor).
You’ll have to wear a special shoe to protect your foot and keep it in the correct position for about 3-6 weeks after surgery.
You won’t be able to resume walking as you did before surgery right away. Start with walking a little each day and slowly building up the time.
It’s different for each patient, but pain from the surgery typically resolves itself fairly soon. Your doctor may prescribe pain medication or recommend over-the-counter painkillers for the first few days after your surgery.
Alert your doctor immediately if your pain does not improve with medication, or if you feel increased pain, warmth or redness as these could be signs of infection.
The cost of hammertoe surgery varies based on the type of hammertoe surgery you need, and whether there are any other issues affecting the health of your toes.
Our foot doctors and billing support department will work with you to minimize costs and can help you with patient financing options for any out of pocket expenses.
Our friendly billing specialists do insurance checks and work with you to minimize out of pocket expenses for any procedure.
Healthcare Bluebook provides an estimate of $2366 - $3585 in out of pocket costs for an outpatient hammertoe correction. While this estimate does consider factors like physician services, anesthesia, and postoperative care, it’s important to remember costs can vary widely based on the patient, region, and type of insurance coverage.
A service called MDsave quotes a similar price range and provides comparison information that may be useful to patients with high-deductible or no health insurance.
Cost information is provided for informational purposes only, and shouldn’t be taken as a firm quote or medical advice. Just get in touch for an assessment and to get a real cost estimate for your specific procedure.
If hammertoe surgery is determined to be medically necessary it’s usually covered by insurance (or Medicare, or Medicaid).
Our podiatrists accept insurance from many different providers and we’re happy to do an insurance coverage check for hammertoe surgery on your next appointment.
Our commitment to putting the CARE back in patient care means we take the time to explain your options, including cost considerations, so you understand what to expect before any procedure.
With any surgery there is a risk of developing complications, even if the procedure went perfectly and you followed aftercare instructions to the letter.
Though rare, there are potential hammertoe surgery complications patients should be aware of:
- Pain, swelling and stiffness
- Blood clot or hematoma
- Nerve injury (neuritis/neuropathy)
- Hypertrophic scars (thick, wide, often raised scar tissue)
- Weakness in toe
- Bones fail to heal properly (nonunion, malunion or delayed union)
- Residual MPJ subluxation (chronic, progressive inflammatory condition in the plantar forefoot)
- Flail toe
Flail toe (also called floppy toe) when the toe is unstable and can’t contract to get a “grip” on the ground when standing or walking. This typically occurs when too much bone has been removed in arthroplasty.
Hammertoe surgery complications are unlikely when you choose an experienced, highly-qualified foot surgeon and follow doctor instructions for postoperative care.
Hammertoe correction without surgery is definitely possible, and your podiatrist may recommend one of several non-invasive hammertoe treatments after your examination.
Hammertoe surgery can help straighten your toes even if other treatments have failed.
Best foot and ankle orthopedic surgeons in Wisconsin
Our elite team of surgical podiatrists plus an orthopedic surgeon provide comprehensive foot and ankle care plus treatments for knee, hip, shoulder and back pain to patients throughout the Milwaukee area from five convenient clinic locations. ¡Somos bilingües! Our podiatrists offer expert care in English and Spanish.
The surgical podiatrists at Advanced Foot & Ankle of Wisconsin are trained in the latest surgical techniques, highly experienced, and capable of performing complex podiatric surgery including reconstruction of the foot and ankle.
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If you suffer from tight, painful hammertoes and conservative treatments haven’t helped, schedule an appointment with our foot doctors today to discuss surgical options.
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