So you’re at the point where you need surgery to fix your hammertoes and you want more information. They way I fix your toe depends on the cause and there are 3 causes of hammertoes. These different causes make the toes bend and twist in different directions. Your 2nd and 3rd toes will bend in a straight line, but your 4th and 5th toes twist as they bend so the nail doesn’t sit on top of the toe any more. Just to clarify, your little toe is #5 and your big toe is #1. Counting from your big toe to the little toe goes 1, 2, 3, 4, and 5.
Let’s start with your 4th and 5th toes. Unfortunately shoes press the hardest on your 4th and 5th toes. Because of this constant pressure I can’t make these toes stiff or you would never wear shoes again without pain. In fact, your 4th and 5th toes are fixed by removing the crooked joint and leaving the toe flexible. Removing the joint will fix the bend, but does nothing to fix the twisting so I have to use a carefully planned skin incision to un-twist your toe and bring the nail back on top. The bandages will help to hold your toe in this position since there are no screws or pins, so it is very important that you do not remove your bandages. To prevent the tendons from pulling on your toe you must wear a special shoe or boot. You will be allowed to walk after the surgery as long as you wear this shoe or boot, but remember that the more time you spend walking around on your foot after surgery the worse the swelling and pain will be. Stitches are removed after 10 days and you will wear a loose fitting tennis shoe before you return to tighter shoes. I expect swelling to last 3-6 weeks, but a lot of that depends on your body.
Your 2nd and 3rd toes are more complicated to fix than the 4th and 5th because they buckle for a different reason. Because of this difference I have to treat these toes using another approach. Your 2nd and 3rd toes must be made stiff so that the muscles won’t cause the toe to buckle again after it has been fixed by surgery. That means that after the surgery your 2nd and 3rd toes will not bend at the toe joint. You will have a screw or pin in your toe to hold the bones straight. The screw or pin can be removed in the office at a later date if needed. No doubt you have heard stories about people having pins sticking out of their toes after hammertoe surgery. I use newer technology when I can so that you won’t have anything sticking out of your toe. It is still important that you not change the first set of bandages after surgery. In straightening your 2nd and 3rd toes I am removing the crooked joint and making the bone ends heal together. You will be able to walk using special cast boot, but again the amount you walk determines how much swelling and pain you get. The bone takes about 1 month to heal. Tennis shoes are easier to wear at first and as swelling and pain subside you can progress to the shoes you want, within reason.
That’s the scoop on the most common hammertoe surgeries. I’ve told you how fixing your 4th and 5th toes are different from your 2nd and 3rd. You have an idea of what to expect after surgery. I have not told you about the more complex toe problems, but will in future posts. For now remember what I always say, “feet are like snowflakes, no two are alike”. The surgical approach from one foot to another has to be different, that’s the art of surgery and is one of the main things separating me from other foot surgeons you might meet.
Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.
