Revision Surgery Series: Hammertoe Revision Surgery

Hammertoe Revision Surgery: What is a hammertoe and symptoms associated with this deformity

Hammertoes are very common deformities and do not always cause pain that require surgery. Numerous conservative options are available to those who do not wish to have condition repaired or have had a failed surgical procedure. A hammertoe is simply a toe that curls, often leading to a prominent bump that rubs the top of a shoe or leads to pain at the tip of the toe from increased pressure at this location.

Repairing this condition can be challenging especially when a severe deformity is present. Complications can and do occur during the post-operative recovery after a surgical correction and how to address these problems is different for every patient.

Not all hammertoes are painful, but when they are patients often have pain in the following areas:

• Top of toe joint – often a red, swollen area where the toe rubs on shoes.
• Tip of toe – the curled toe leads to pressure to tip of toe or directly to end of toenail
• Ball of foot behind affected toe – often the curled toe is due to a long metatarsal bone behind the toe. This long bone caused the toe to pop up and rub in shoes.

Surgical repair of previously failed hammertoe surgery:

When repairing a hammertoe deformity two basic procedures are performed after intital presentation; arthroplasty or arthroplasty with joint fusion.   

• Arthroplasty - a portion of the joint is removed resulting in a straighter joint but maintaining flexibility at this level.  This allows for possible recurrence. 
  • Complications
    • “Flail Toe” - the toe becomes "floppy" because too much bone was removed.
      • Treatment – removing the opposing joint surface and fusing the joint with implant or pin.
    • Return of flexed position of toe
      • Treatment - removing the opposing joint surface and fusing the  joint with implant or pin
• Arthroplasty with Joint Fusion - opposing cartilage from both sides of joint is removed and the joint is allowed to fuse/heal together. If complete fusion occurs, the joint cannot bend at this level again and deformity cannot return.
  • Complications
    • Nonunion – occurs with the opposing bones do not join and the space fills with inflamed scar tissue. This can be very painful!
      • Treatment – if conservative care has been exhausted, surgery would require removal of unhealed bone and previous implant, then repeating previous fusion procedure
        • Specialty implants have been designed for these revision case
    • Toe is not straight – toe is angled up, down, left or right due to poor alignment at fusion site
      • Treatment – removal of implant if present, and removal of angled bone at the joint level. A pin or implant is placed in the toe to maintain stability during healing.
    • Joint pain in the ball of foot behind affected toe – often a contracted toe is caused by a long metatarsal bone behind the toe. Prolonged contracture of the toe can also cause joint damage on the bottom of foot that should be repaired, this is called a plantar plate tear.  
      • Treatment – when pain occurs in the ball of foot the metatarsal bone needs to be shortened and fixated with a screw(s) while it heals.  This allows the toe to be straightened and also permits inspection of joint surface for tearing which can be repaired at this time.

This list in no way encompasses all the treatment options for revision of a painful outcome from a hammertoe surgery. Every hammertoe complication is different and requires special evaluation of patient history, x-rays and physical exam. 

Recovery from hammertoe revision surgery:

In most revision surgery cases, the length of recovery is similar to the original surgery. Most hammertoe procedures allow patients to return to full normal activity in about 6-8 weeks, but every patient’s recovery is slightly different. 

Typical recovery from hammertoe surgery is as follows:

• 4-6 weeks in a stiff soled surgical shoe – office evaluation of post-operative pain and healing determines timing of transition into an athletic shoe
• Athletic shoes are worn for 2-4 weeks while final healing occurs.
• Pain at surgical site is typically better at 8 weeks after surgery than it was before surgery, and continues to improve over the period of about six months.

The most important thing to understand about a previous failed hammertoe surgery is that there are solutions to your problem. Very rarely are there no options, and if you are told this by your current physician you probably need a 2^nd opinion. Not every poor outcome is the fault of your surgeon, and surgical complications do occur, but you don’t have to live with the results!

It is always helpful when coming for a second opinion to obtain your previous pre-operative x-rays prior to your appointment. Request an appointment and let us help you get on the road to recovery!