When Does Hammertoe Require Surgery?

Aug 01, 2023
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When you first develop hammertoe, conservative treatments often relieve pain and restore the toe’s normal shape. However, the pain can worsen without treatment, eventually reaching a stage where surgery may be necessary.

Hammertoes are one of the most common deformities of the forefoot. So it’s no surprise

Board Certified Podiatrist Dr. Babak Kosar, with offices in the Valencia and Northridge neighborhoods of Los Angeles, CA, has treated countless cases of the condition. 

Here, he breaks down the causes of hammertoe and explains when surgery is your best course of action.

Underlying causes of hammertoe

Typically, it develops in your second, third, and fourth toes. The problem starts when the middle joint in the toe bends abnormally, forcing the tip of your toe to turn downward rather than straight out. The deformity looks like the shape of a hammer.

Improperly fitting shoes are the most common cause of hammertoe. Narrow-toed shoes can squish your toes into a bent position. High heels cause a similar problem, as they force your toes against the front of the shoe.

When shoes constrict and bend your toes over time, the muscles shorten to accommodate the position.  

You’re more likely to develop a hammertoe if you have an inflammatory joint disease like arthritis. Bunions also raise your risk because they push your big toe into your second toe, which may force your second toe into a downward, hammertoe position. 

Pain and other symptoms 

Not being able to straighten your toe is a prominent symptom, but hammertoe is also painful, affecting the top or the base of your bent toe. You may also experience pain in the ball of your foot and when you move your toe.

A painful corn often develops as the top of the bent toe rubs against your shoe. Patients with hammertoes also tend to develop calluses, adding to their discomfort. 

Non-surgical treatment options at an early stage 

If your toe is still flexible, we can treat the problem with various non-surgical options. These may include one or more of the following: 

  • Splinting or taping to realign the toe
  • Shoes with a larger toe box and low heels
  • Exercises to stretch muscles in the hammertoe
  • Shoe padding to prevent ongoing irritation
  • Custom orthotics to relieve pressure and restore muscle balance
  • Corticosteroid injections or topical medications to reduce inflammation and alleviate pain

Without early treatment, hammertoe usually worsens. The muscles and tendons stay tight, and the toe becomes rigid and fixed in its bent position. Now the toe is in a state of permanent contracture.

When hammertoe requires surgery, 

Surgery is likely necessary for relief if your toe is stiff and causing pain.

There are several types of hammertoe surgery. 

Flexible hammertoe

Even when your toe is still flexible, it’s possible to have enough pain and difficulty moving to consider surgical intervention.

The most common surgery for flexible hammertoe is straightening the toe with a tendon transfer. This procedure involves rerouting tendons to maneuver the bent joint back into a straight position. 

Rigid hammertoe

In this case, we may recommend a joint resection or a bone fusion. During a joint resection, part of your bone is removed so your toe can return to its normal position. In a fusion, the toe is straightened, and the bones are fused, preventing the toe from bending.

Hammertoe surgery is outpatient, so you go home the same day. Full recovery can take weeks, however, depending on the type of surgery. After surgery, you must keep your foot elevated, so you should plan for downtime.

If you’re suffering from hammertoe discomfort, early intervention is critical.  Schedule your consultation with Dr. Babak today.