Hammer toe results due to the abnormal bending of one or both joints of the four smaller toes of the foot. It is a progressive disease that affects one or more toes at the same time, often starting as a mild deformity that gets worse with time.
Hammer toe in an individual may result in constant pain, making it difficult for him/her to walk or even stand on the foot for longer periods. The condition may also lead to the formation of corns or calluses on the tip of the toes or on top of the middle joint of the toe, causing a lot of pain and discomfort when wearing shoes.
Though the symptoms are easier to manage in the early stages as the hammer toes are still quite flexible, they might become more rigid in the absence of treatment, often necessitating surgery during the later stages.
When Surgery Becomes Necessary
Progressive loss of flexibility in hammer toes may result in permanently bent toes that rub on the shoes to the extent of being sore and painful. Though anti-inflammatory medications, pads, splints and extra-wide shoes can provide some comfort, they are not capable of straightening the toes.
With time, the tip of the toes may even develop calluses or corns that are particularly painful and especially difficult to treat. The bending gets worse with time and may even affect the joint at the ball of the foot, resulting in considerable pain and discomfort.
In more severe cases, the joint may become dislocated due to the rupturing of the joint capsule. In such cases exercises, splints and orthotics fail to provide effective treatment, necessitating surgical intervention.
Procedure of Hammer Toe Surgery
The most common surgical procedures performed to relieve the symptoms of hammer toe include digital arthroplasty, digital arthrodesis and tendon transfer. The surgery is performed either under local anaesthesia or general anaesthesia.
This is the most common surgical procedure performed for hammer toe. The procedure involves removal of a small section of bone from the affected joint to release the contracture. More severe cases may require additional release of the joint capsule and the tendon towards the front of the foot.
Implant arthroplasty or joint replacement is another common procedure that involves replacing the affected bone with an implant made of rubber, silicon or metal to retain the size of the toes.
Digital arthrodesis is performed for more severe cases that involve multiple joints or rigid toes with bunion deformity. The procedure involves fusion of the small joints of the toe to straighten them.
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The surgeon may use a small fixation device or a pin to hold the toes in place to facilitate healing of the bones.
Tendon transfer is usually done for toes that are still flexible or it might be done in combination with other surgical procedures to improve the flexibility of more rigid toes.
The procedure involves re-routing the tendons from the top of the toe to the bottom to release contracture and improve positioning.
What to Expect After the Surgery
The stitches are usually removed 8-10 days after the surgery, whereas the pins may be removed after 6-8 weeks. Some doctors may opt for dissolvable pins that do not require extraction and need no extra prevention to keep the pins in place. You can expect some degree of pain, swelling and stiffness in the toes for a couple of days following the surgery.
The rate of recovery generally depends on the number of toes that were operated upon and the extent of surgery required. Some patients might be able to resume their daily activities immediately after the surgery, whereas others may take as long as 8-12 weeks to be able to walk again. Ideally, restricted activity for at least 24 hours after the surgery and wearing a splint for 2-4 weeks is advised. You may also be advised upon appropriate foot wear and exercises to strengthen your toes.
Complications After Hammer Toe Surgery
The hammer toe surgery brings along associated complications such as risk of infection and nerve damage. Some patients may also experience limited range of motion and decreased mobility in the toes.
Though some degree of numbness is normal and may persist in the operated area even after a few months post the surgery, excessive pain, redness and excessive swelling usually indicates an infection and should be treated on an urgent basis. Presence of other symptoms such as fever and vomiting may also indicate post-operative complications and should be reported immediately.
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