A hammertoe is a toe that is bent at the middle joint so that it is in a curved position. It can be caused by muscle imbalance, shoes that don’t fit well, and/or arthritis. A number of factors may work together to cause this condition. Initially, a hammertoe may be flexible and easily corrected, but if untreated, it can become fixed and require surgery. A hammertoe can become painful, cause thick callouses, and even interfere with walking. Some people find the appearance of a hammertoe unsightly.

1. X-rays of the affected foot will be taken so your doctor can determine the best plan of action and visualize the area that will be treated.
2. You will undergo a physical examination as well as blood tests, chest x-ray, and an electrocardiogram (EKG) to ensure that you are healthy enough for anesthesia and surgery.
3. Please let your doctor know about all medication that you are taking as some will need to be stopped before the procedure, such as aspirin, Persantin, Ticlid, Plavix, warfarin, heparin, and Fraxiparine. (These will usually need to be stopped for at least one week before the surgery or as recommended by the doctor.)
4. Get enough rest and avoid smoking cigarettes and drinking alcohol before the procedure as these can increase your risk of complications.
5. If you are sick or have a fever on the day before surgery, let the doctor or hospital know immediately.
6. You will likely need to avoid food and water for at least six to eight hours before the procedure, or as recommended by the doctor.

The type of anesthesia used will depend on the extent of the procedure. You may receive local anesthesia with intravenous sedation or general anesthesia, in which case you will be asleep. Your doctor will decide which procedure is best suited for your condition and will result in realigning the toe and improving its function. Tight tendons may be lengthened or tendons may be transplanted to help your toe move better. Portions of your bone may be removed or a steel pin may be inserted to correct the toe. Bones may be fused together to prevent it from bending at all. The type of hardware placed (if any) will also depend on the procedure. Incisions are closed with stitches.

After the procedure you will be moved to a recovery room and most patients are able to return home the date of the procedure after resting for a few hours. Your foot will be bandaged and you will need to use crutches to walk around. Some pain and discomfort are normal and you will be prescribed medication to manage it, as well as antibiotics to prevent infection. Complete recovery can take one to three months, depending on the extent of the surgery.

You should be able to walk fairly comfortably after two weeks, but it is recommended that you don’t walk for long periods for at least one month after the procedure. Some patients will be able to wear wide, comfortable shoes after a few weeks, but if you had a hardware implanted during surgery, they may need to be removed first. You can return to work a week or two after surgery, depending on how much activity is required of you. Please wait four to eight weeks to drive and even longer before returning to sports and exercise. Full healing can take a year.

There are always risks associated with surgery, such as bleeding, infection, and reaction to anesthesia. Risks and complications specific to hammertoe correction surgery include:

• Poor alignment of the toe.
• Infection in the bones.
• Injury to nerves.
• Stiffness in the toe or a toe that is too straight.

Before the Procedure

·        The patient will be evaluated and diagnosed by the doctor before surgery is planned and the surgery will take place as soon as possible, depending on the patient’s readiness. This can be one to two days or within 24 hours.

·        It is recommended that you stay at a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.

After the Procedure

·        You should plan to remain in Thailand for at least one week through the duration of your treatment. This may vary from person to person, depending on your individual health and medical condition before the procedure as well as your age. Certain factors may require a longer stay in Thailand.

·        When you return for your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation of your treatment history, a document detailing the model of the hardware placed (if required), follow-up appointment slips, your “fit to fly” certificate, and a Medical Information Card (Bone Card) if the bone needed to be stabilized.

·        You may travel by car if it is a four-seater and it is recommended you sit in the passenger seat with the seat reclined. If you are traveling in a van, it is recommended you sit behind the driver and recline your seat.

·        Normally patients can travel home by air. Please discuss this with your doctor to confirm that you are healthy enough to fly before making flight arrangements. If you need a walking aid, such as a walker, crutches, or cane, be sure to let the airline know in advance if you will need a wheelchair at the airport and when you get off the airplane at your destination.

§  If you are traveling in First or Business class:

–         You can adjust or recline your seat normally. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation.

–         Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol. If you have been prescribed venous thromboembolism (VTE) prophylaxis, follow your doctor’s instructions strictly.

§  If you are traveling in Economy Class, be sure to select a seat in the exit row or a bulkhead seat.

–         You can recline your seat normally. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation. Please get up and move around at least every 30 minutes.

–         Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol. If you have been prescribed venous thromboembolism (VTE) prophylaxis, follow your doctor’s instructions strictly.

The procedure is effective and patients are able to walk comfortably approximately two weeks after the surgery, except in the cases that equipment must be placed. In that instance, the equipment will need to be removed first before the patient can walk normally.
 

What if this procedure is not done?

A hammertoe does not resolve on its own and symptoms can interfere with daily life. In some cases, the situation can worsen enough to cause permanent damage to your foot.

Before surgical methods are considered, the doctor may recommend other treatments to manage your symptoms, including wearing supporting shoes, using an arch support, changing your activities, and caring for callouses. Medication may help reduce pain and inflammation. Physical therapy can help with muscle function. Toe splints or pads may prevent pain and irritation while wearing shoes. Cortisone injections may also be recommended to decrease pain and swelling.