Minimally Invasive Hammertoe Correction

What is a hammertoe?

A hammertoe is a common deformity that occurs at the lesser toes leading to pain, discomfort, and difficulties in wearing shoes. Patients usually suffer from pain at various locations in the forefoot such as at the ball of the foot, top of the toe, and tip of the toe. It often affects the 2nd toe most commonly but can involve all lesser toes. Pain can come from pressure between adjacent toes, with the shoe, and against the ground upon weight-bearing.

The causes of hammertoe are multifactorial, but they are believed to be closely related to a bunion of the hallux. A bunion can lead to overloading of the adjacent lesser metatarsal heads with failure of the plantar plate and eventually hammertoe deformity. Hammertoe deformity may be flexible or rigid depending on the severity and chronicity of the condition.

What is the treatment for a hammertoe?

The development of hammertoe may be prevented by avoiding excessive use of high-heeled and narrow shoes. There is no effective non-surgical treatment that can correct a hammertoe deformity. Patients may find relief by using shoes with a wide toe box, open-toe shoes, or custom shoes. Exercises of the intrinsic muscles in the foot can promote more muscle balance. Silicone pads may be used to minimize soft tissue irritation against the shoe or adjacent toes. Toe straighteners can be helpful in balancing the load at the forefoot and decreasing pressure from the shoe uppers.

Surgical treatments are the only route to correct the deformity and relieve pain as the definitive treatment. There are numerous surgical strategies to correct hammertoes including tendon release, tendon transfer, PIP joint resection, PIP resection arthroplasty, and rarely an amputation. Each hammertoe is different, and an ideal treatment needs to be tailored customized for each patient, each foot, and each toe.

What is a minimally invasive hammertoe correction (MIS)?

Minimally invasive hammertoe correction (MIS) is based on the philosophy that the goals of the surgery can be met with the least amount of collateral damage possible. It is comparable to cardiac catheterization to fix a clogged artery rather than having a formal open thoracotomy. The cornerstone of the MIS is to use a special bone cutting bur that can allow bone cutting and trimming through 3-mm stab incisions. Contracted tendons can be released through stab incisions. Soft tissue balancing procedures can be added using percutaneous techniques to minimize big incisions. There is no need to use screws or pins to maintain the correction, so hardware-related complications are avoided. The desired toe alignment is maintained using taping and wrapping every 2 weeks until 6-8 weeks postoperatively.

While the surgery appears attractive, MIS hammertoe surgery is extremely technical and each surgeon performing it must go through rigorous and multistage training in sawbones and cadavers prior to real patients.

What are the risks and benefits of MIS hammertoe correction?

Risks: nerve damage, bone shortening, inadequate correction, non-union

Benefits: Minimal postoperative pain, Immediate weight-bearing, cosmesis, less scarring, less swelling, faster recovery, no hardware fixation required

What is the recovery after a MIS hammertoe correction?

Dr. P’s postoperative protocols include immediate weight-bearing using 100% body weight starting on the day of surgery. The patient may achieve this by either using crutches or a walker to assist with balance while putting weight on a provided post-op shoe. Patients will do weight-bearing for light ADLs such as going to the bathrooms or kitchen or short walking inside the house. Full weight-bearing is healthy for the foot as it allows the bone and soft tissue to self-adjust to the flat surface. The amount of walking can be gradually increased, and a walker or crutches can be weaned off at 2 weeks. The patient can return to normal running or tennis shoes at 6 weeks. Sports and higher impact activities can start at 10 weeks. Patients will not need to do any dressing change themselves but will return to the clinics at 2 and 4 weeks for bunion dressing by Dr. P. Driving can normally resume when the patient stops taking pain medication and can walk comfortably; a trial of driving under family-member supervision is recommended.

What if I have a previous hammertoe repair with persistent pain or deformity?

The patient should be thoroughly evaluated to explore the causes of persistent symptoms. Investigations such as x-rays, CT scans, MRIs, or diagnostic injections may be needed. MIS techniques can be applied to many patients with residual deformity, bony prominence, nonunion, or contracture.

Why should I choose Dr. P for a MIS hammertoe correction?

-Dr. P is the pioneer and leader in minimally invasive surgery (MIS) of the foot and ankle.

-Dr. P is one of the most experienced MIS experts in the Midwest who has performed hundreds of MIS procedures.

-Dr. P is an instructor for MIS hammertoe correction who has taught numerous surgeons around the country

-Dr. P is patient-oriented for achieving goals and expectations of successful outcomes

What do patients say about Dr. P?