Hammer Toes and Mallet Toes

What are Hammer Toes and Mallet Toes?

Hammer toes and mallet toes are deformities of the lesser toes that can occur due to an imbalance in the muscles, tendons and ligaments that normally hold the toe straight. A hammertoe has an abnormal bend in the middle joint of the toe. A mallet toe has an abnormal bend in the joint nearest to the toenail. These toes can tuck under or cross over other toes. 

Symptoms

  • Downward claw-like bend in the toe
  • May be painful
  • Movement of the toe can be difficult
  • Corns and callus may form due to rubbing on footwear
  • Hammertoes can also create pressure, pain and callus on the ball of the foot

Causes

Some of the contributing factors that can cause hammertoes include:

  • Injury / trauma
  • Muscle imbalance in the toes
  • Nerve damage
  • Unsupportive footwear with a narrow toe box
  • Other deformities such as a bunion that can cause the lesser toes to be pushed out of alignment

Non surgical treatment options

Non surgical treatments are aimed at reducing pain and preventing further deformity from occurring. These treatment options include:

  • Appropriate footwear
  • Protective devices for the affected toes
  • Toe exercises may help strengthen and stretch the toe muscles

Surgical treatment options

If the toe deformity is quite problematic and non surgical treatment fails to provide relief, then surgical intervention may be the only viable option. There are severe surgical techniques that may be used:

  • Tenotomy: This procedure involves cutting the tendon in the toe to allow it to lengthen. This can be performed under a local anaesthetic and has a reduced post-operative recovery period. 
  • Arthroplasty: This procedure involves removing a small section of the bone from the affected joint. Some deformities also require release of the joint capsule and tendon. 
  • Arthrodesis: This procedure is utilised for severe and rigid hammertoes and involves using a small joint in the toe to straighten it. A pin is used to hold the toe in position whilst it is healing, and is often left in place for 6-8 weeks.

Post operative recovery

Your foot will be dressed and bandaged after surgery and fitted into a post-operative shoe. You will be required to wear this shoe day and night for approximately 2 to 4 weeks following surgery. 

Hospital stay

Surgery is usually performed as a day case providing you are medically fit, and have someone who can collect you and look after you following the operation. 
If you have medical problems such as diabetes, asthma or high blood pressure, you may have to stay overnight after surgery. If you cannot be collected and looked after, you must stay overnight to avoid complications.

Anaesthesia

Generally surgery is performed under light sedation. Local anaesthetic is injected into the foot while you are sedated to reduce post-operative pain. You will also be provided with pain relieving medication after the surgery. The anaesthetist will consult with you at the hospital prior to surgery and will discuss the anaesthetic process in full.

How soon can I...

Walk on the foot?

You will be able to walk immediately after surgery, although you can only do so for ten minutes of every hour. Your podiatric surgeon will advise you further. 

Go back to work?

This depends on what you do for work and how you travel to work. You will require a minimum of 2 weeks off work if you have an office job that allows you to elevate your foot for the majority of the day. If your job requires you to be standing or walking for extended periods, you will require a minimum of 4 to 6 weeks off work. Your podiatric surgeon will advise you further.

Drive?

For an automatic car, you will be able to drive immediately if surgery is performed on your left foot. If surgery is performed on the right foot and depending on the type of car you drive, you will be able to drive from 1-4 weeks after surgery.  Your podiatric surgeon will advise you further.

Exercise?

Every patient is different in how quickly they can resume exercise again: be guided by your own body's reactions and the advice of your surgeon. The majority of people can return to most of their previous activities within two months of their surgery, however this is only a guideline.

Can there be any complications?

Although complications are unlikely, these can arise after any episode of surgery. These can include (but are not limited to):

  • Infection: Antibiotics are given before and after surgery to reduce the chances of infection however it can still occur.
  • Nerve injury: Minor damage to the nerves of the toe can occur as a result of small sensory nerves being caught in scar tissue. It may cause an area of numbness or sensitivity.
  • Wound healing difficulties: Problems with wound healing are rare and tend to occur primarily with patients with diabetes and smokers. If you do smoke, it is recommended that you stop smoking at least four weeks prior to surgery.

 

Lee Gray
Practice principal, she founded the practice in 1981 and focuses exclusively on surgical treatment of the foot