Hammertoes and Clawtoes Correction
Surgery
Surgery to correct lesser toe problems is done as an outpatient. It can be done with a general anesthetic or an ankle block. If both feet have hammertoes they can be corrected at the same time, or they can be done singly. Most people choose to have both sides corrected at the same setting so they only have one anesthetic, and only one recovery period. I routinely allow you to walk with all of your weight on the operated foot, so it is possible to have both sides done and still be able to get around. In some cases, I will cut the metatarsal bone, and put a tiny screw in to hold the pieces together. If that is done, I will let you put weight on your heel, but not on the ball of your foot. Some patients have other forefoot problems, such as bunions or Morton’s Neuroma that can also be treated at the same time.
One or two incisions are usually made to correct a hammertoe. There may be one on the top or bottom of the toe itself, and a second incision further back over the top of the forefoot at the base of the toe. The incision on the top of the toe is made to take out a small piece of bone. The one under the toe is used to release a tendon, if that needs to be transferred. The proximal one at the base of the toe is used to release the tight joint capsule at the base of the toe, and to lengthen the tight extensor tendon.
During the surgical correction of hammertoes it is common to place a thin wire through the toe to hold the position of the toe. These are called K-wires. These wires are meant to stay in place for 4 weeks, and then they are removed in the office.
If it is necessary to cut the metatarsal bone during the correction, a metatarsal osteotomy, I will put a tiny screw in to hold the cut bones in place. This screw is meant to remain in place forever.
Day of Surgery
At the end of the surgical procedure the wound is covered and the foot is wrapped with a dressing that is securely taped into place.
That dressing gives support to the foot, acting like a cast to hold it securely. That dressing should be left in place until I change it at the first post-operative office visit.
You will be given a post-operative shoe at the surgery center, and unless I tell you differently, you may put all of your weight on the foot if you have that shoe on. You must not walk on the operated foot unless you are wearing the post-operative shoe. Some people sleep with the shoe on for the first few days after surgery because it gives them a sense of more security, and may protect the protruding pins, but you do not have to keep it on unless you are walking.
If during your surgery I cut the metatarsal bone, a metetarsal osteotomy, then I will allow you to put weight on your heel, but not on the ball of your foot.
You should try to keep your foot elevated as much as possible to minimize swelling.
If the dressing gets wet or there is a problem with it, please call the office so I can remove it myself.
Post-Operative Care
Dealing with post-operative pain will be your major concern for the first few days.
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the dressings, wash your foot, and generally take out the skin stitches.
After I take out the skin stitches you can shower or bathe your foot, then towel it dry and put a clean sock over it. I will give you some thin tube socks that you can use while you have the pins in place. They generally do not put any pressure on the pins, and may feel better than your usual sock. You will continue to use the post-operative shoe until 4 weeks have passed after the surgery. You should not sit in a hot tub until 2 weeks after surgery. If your surgery was on the right side you should not drive until 4 weeks after surgery.
The second post-operative visit is usually at the 4 week point. At that time I will remove the pin or pins from the corrected hammertoes.
You may then begin wearing whatever shoe feels comfortable on the operated foot. You may walk as much as feels comfortable, but should not do any more vigorous activities for another 4 weeks. You may drive when you can wear a regular shoe on the right foot.
The next visit is usually the final one, and it will be after an additional 4 – 6 weeks. If there are any problems or questions then we will deal with them as they present.
Most patients have swelling about the toes that lasts for about 4 months after surgery.
Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal activities and unrestricted shoewear. You should be able to regain full strength and power in the foot.
Because bone may be removed during the surgery, or tendons are transferred, you may always have a slight “pudgy” appearance of the operated toe or toes. Generally the toes will maintain a satisfactory alignment, but you will not have as much ability to move the toes as you normally would. No more picking up quarters with your toes. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.
Complications
Complications can occur with any surgery.
Specific risks of this surgery include problems with the K-wires.