Toe Deformities

What is Hammer / Mallet toe?

A hammer toe is a deformity of the “knuckle” of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer.

Mallet toe is a similar condition affecting the end joint of the toe.

A hammer / mallet toe is often found in conjunction with bunions or other foot problems. It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis or rheumatoid arthritis.

Why do you need this operation?

You should have initially tried other treatment options such as avoiding shoes which rub on the toe; wearing new shoes with soft, spacious toe box; or padding to the toe.
In more severe or longstanding cases surgery may be necessary to correct the deformity.

What does the operation involve?

The operation is done as a day case but come prepared in case you need to stay overnight. The operation is normally performed with general anaesthetic and nerve block (which means numbing the nerves of the foot).
The operation involves an incision over the bent joint of the toe. The joint is removed and fixed using a metal wire. A soft tissue release (lengthening or transferring tendons) is often needed at the top joint of the toe.
The metal wire is used to temporarily hold the toe straight whilst bone healing occurs and is then removed six weeks following surgery in the outpatient clinic.

Your post-operativeperiod

You will have a bandage on your foot
You will go home with a surgical sandal on your foot
You must keep your foot raised for the first week
You can walk with your foot bearing your full weight
Use crutches if needed.

Your follow-up

At two weeks stitches are removed and dressing is reduced
At six weeks x-rays are done and the metal wire is removed from the toe
Back into wide fitting shoes at six weeks
Off work for about two weeks, depending on your job
No driving for up to six weeks.

If the second toe is over-riding the big toe as part of a bunion, correction of the bunion is sometimes necessary to create room to correct the second toe.

What are the possible complications?

Ongoing pain
Recurrence of the toe deformity
Numbness / altered sensation
Infection
Swelling of the toe can persist for some months
The wire used may break
In severe deformities, the correction can stretch the vessels blocking the circulation to the toe. This might require removal of the wire, leaving the toe to go back in the deformed position.
Clots in the leg (DVT)
Clots in the lung (PE)
Chronic Regional Pain Syndrome.

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood thinning medication increases possible risks significantly.