Background Information:

What are the other Names for the Procedure?

• Correction of Hammer Toe
• Hammer Toe Operation
• Repair of Hammer Toe

What is Hammer Toe Correction surgical procedure?

A Hammer Toe Correction is a surgical procedure used to correct an abnormal configuration, wherein the 2^nd, 3^rd, 4^th, or 5^th toe joint, is bent downwards.

What part of the Body does the Procedure involve?

A Hammer Toe Correction involves all toes of the feet (except the big toe), the surrounding tendons, blood vessels, underlying skin, and the nerves associated with these toes.

Why is the Hammer Toe Correction surgical procedure Performed?

A Correction of Hammer Toe is performed for the following reasons:

• Relieve pain caused by calluses
• Avoid permanent abnormality of the toe

What are some Alternative Choices for the Procedure?

Some alternative choices include the use of:

• Supportive shoes
• Use of an arch support
• Shoes with a wide toe box
• Modification of activities that worsen the deformity
• Callus care
• Anti-inflammatory medications that decrease pain and inflammation
• Physical therapy to strengthen and stretch muscles
• Custom foot orthotics
• Toe splints and pad
• Steroid injection to the affected toe
• Non-surgical treatment methods are aimed only to decrease symptoms and/or limit the progression of the deformity.

What are the Recent Advances in the Procedure?

A surgical correction of hammer toe remains the gold standard approach in treating hammer toe deformities.

What is the Cost of performing the Hammer Toe Correction surgical procedure?

The cost of Hammer Toe Correction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

It is normal for a patient to feel uncomfortable and confused by the information regarding a Hammer Toe Correction and on what needs to be done

If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://bunionsurgeryny.com/procedures/hammer-toe-surgery-toe-job-toe-augmentation-or-toe-shortening/

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Hammer Toe Correction surgical procedure:

How is the Hammer Toe Correction surgical procedure Performed?

Two methods are commonly used to correct hammer toes, which include: Arthroplasty and Bone-mending procedure

Arthroplasty (Joint resection procedure):

• There are 3 joints in the 2nd, 3rd, and 4th toe
• The 1st  joint is between the ball of the foot and the toe; the other 2 joints are in the toe itself
• In an arthroplasty (joint resection procedure) for hammer toe deformity, one of the two joints within the toe is resected (surgically removed) in order to make room for the toe to be re-positioned flat
• The resection does not involve the joint of the ball of the foot

Bone-mending procedure:

• In this procedure, the contracted toe is realigned by removal of the entire deviated joints of the toe (not at the ball of the foot)
• This allows for the toe to be positioned flat and the bone ends, to mend together
• Surgical hardware fixation is necessary to keep the bones steady during healing. The hardware may be a buried implant inside the toe, or a temporary wire that is later removed

Toe relocation procedures are sometimes performed in conjunction with any of the methods listed above. When the toe is deformed at the ball of the foot, then this joint is re-positioned along with ligament release/repair, to get the toe straightened.

Where is the Procedure Performed?

A Hammer Toe Correction procedure is usually performed in an out-patient surgery center facility or a hospital. Normally, the individual can go home, once the procedure is completed.

Who Performs the Procedure?

A Repair of Hammer Toe procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

• An orthopedic surgeon
• A podiatrist
• Occasionally, it is performed by a general surgeon

How long will the Procedure take?

It takes anywhere between 30 minutes to 2 hours, depending on the type of surgery performed.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Hammer Toe Correction procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hammer Toe Correction surgical procedure?

Prior to a Hammer Toe Correction procedure, the individual may have to undergo certain tests, such as:

• Physical examination
• Routine blood analysis
• X-ray of the feet

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Hammer Toe Correction procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Hammer Toe Correction surgical procedure:

What kind of Anesthesia is given, during the Procedure?

An injection of local anesthesia, regional anesthesia, spinal or general anesthesia is administered for this procedure.

How much Blood will you lose, during the Procedure?

Since Hammer Toe Correction is a less invasive procedure, the amount of blood loss is generally minimal.

What are the possible Risks and Complications during the Hammer Toe Correction surgical procedure?

There are general factors that increase the risk of getting complications during surgery, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Hammer Toe Correction surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Hammer Toe Correction surgical procedure:

What are the possible Risks and Complications after the Hammer Toe Correction surgical procedure?

Post Hammer Toe Correction procedure, the following complications may arise:

• Excessive bleeding
• Excessive swelling, which is present several months after the procedure
• Recurrence of hammer toes
• Infection in the surgical wound
• Accidental injury to the neighboring nerves or blood vessels

What is the Prognosis after the Surgery?

• The recovery depends on the method of surgery performed
• Healing generally takes about 6 weeks
• Prognosis is excellent, when the procedure is performed by experienced hands

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling surrounding the surgical wound
• Bleeding or fluid drainage around the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea and vomiting
• Signs of an infection
• Fever
• Dizziness
• Muscle aches
• Fever
• Feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Hammer Toe Correction surgical procedure?

At home, the following post-operative care is recommended, after a Hammer Toe Correction procedure:

• Use a heat pad or warm compress to relieve pain, due to the incision
• Keep the wound clean and dry
• Wear proper footwear that does not put any unwanted stress on the foot
• Wear flat shoes and cotton socks during the healing process
• Complete the course of prescribed medication
• Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, if necessary
• Resume driving only a week after surgery, or follow your physician’s advise
• Avoid all activities that are physically strenuous, for about 6 weeks

How long does it normally take to fully recover, from the Procedure?

• It usually takes about 6 weeks to fully recover from the procedure
• Individuals are often able to resume their normal activities, anywhere between 2 weeks to 3 months, after the surgery. However, this is also dependent on the severity of the deformity, prior to surgery
• Those who have undergone a simple toe surgery, especially performed on the 4th and 5th toe, can recover quicker (as early as 2 weeks), as these toes are not needed for propulsion

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Hammer Toe Correction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• An anesthesiologist (if anesthesia was administered)
• An orthopedic surgeon, a podiatrist, or a general surgeon with experience in Hammer Toe Correction

The patient is advised to inquire and confirm the type of billing, before the Hammer Toe Correction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA