Hammer, mallet & claw toe surgery

What is a hammer toe?

Hammertoe (mallet toe, claw toe) is a deformity in smaller toes due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight. You may find your hammer toes unpleasant to look at. 

Often one condition leads to the other in the affected toes. 

Ready to book now? Get in touch to discuss your needs and decide on the best course of treatment for you.

Ready to book now? Get in touch to discuss your needs and decide on the best course of treatment for you.

What are the differences between hammer toes, mallet toes and claw toes?

Hammer toes are often confused with mallet toes and claw toes. However, there are key differences between these toe deformities. 

  • Claw toes: The bend is in the first toe and second joints. 
  • Hammer toes: The bend is in the second (or middle) toe joint. 
  • Mallet toes: The bend is in the third toe joint. 

What causes toe deformities?

Generally, these toe deformities may happen because of an imbalance in the muscles and tendons used to keep the toes straight versus the muscles and tendons which bend the toe joints. If left untreated, these issues can worsen over time, shortening the tendons. Eventually, the deformities will be uncorrectable without surgery. 

  • Ill-fitting footwear -The most common cause of these toe conditions is because of toes being cramped from wearing ill-fitting footwear, pointed toe footwear, heels or flat and unsupportive footwear. These conditions are common in middle-aged females who have historically worn ill-fitting footwear for many years 
  • Neuromuscular disease – Neuromuscular diseases can contribute toward the development of a hammertoe. People with diabetes can be at increased risk of toe deformities due to neuropathy and poor blood flow. For example, for diabetics, a toe with a corn or other ulceration indicates there’s too much pressure on the toes. 

What are the symptoms of these toe conditions?

Symptoms of these toe deformities include: 

  • A toe joint that’s getting rigid 
  • Pain at the top of the bent toe 
  • Pain in the ball of the foot 
  • Corns and calluses at the top of the toe joint 
  • Redness, inflammation or burning of the toes 
  • Painful or restricted motion of the toe joint 
  • Joint swelling 
  • Your big toe pointing toward other toes. 

What happens during hammer toe, claw toe and mallet toe surgery?

Hammer toe, claw toe or mallet toe correction surgery will straighten the affected toe and is the only way to permanently correct these conditions in severe cases. Surgery will restore proper alignment in the joint either by removing bony lumps, adjusting or removing the joint or altering the tendons to straighten them.  

Your surgeon may choose to carry out one or more correction procedures, depending on your specific case. 

Surgical options include: 

  • Tendon release: Cutting a tight toe tendon to allow the toe to lay flat. 
  • Tendon transfer: Moving the tendon in the toe to another part of the foot, to force the toe to straighten. 
  • Digital arthroplasty. An arthroplasty removes half of your joint and leaves some movement in your toe 
  • Digital arthrodesis. An arthrodesis removes all of your joint to straighten your toe. A wire will keep your toe straight until your bone has healed. It is then removed 
  • Plantar plate repair. A controlled fracture is performed to lift up the bone. The ligament is identified and repaired through the same incision, or occasionally from under the foot. 

The toe’s new position will be held in place with pins or wire. 

Surgery can be done under local or general anaesthetic and is typically an outpatient procedure. This means that you can go home a few hours after the operation and after the anaesthesia has worn off.  

Preparing for hammer toe, claw toe and mallet toe surgery

Your surgeon will give you simple preparation advice to help you get ready for your operation. To ensure that you are fit for surgery under general anaesthetic, you will undergo a few medical checks. A general anaesthetic can make you sick so it’s important that you don’t eat or drink anything before surgery. 

You may be advised to stop taking medications a few days before surgery, particularly if you take aspirin or other blood-thinning drugs.  

If you smoke, you may be advised to stop. This is because smoking increases your chances of getting a wound infection, which can slow down your recovery after surgery. 

It is advised that you prepare your home and living arrangements for your return from hospital. It may be challenging to move around at first after surgery, particularly if you are using crutches. You may need to rearrange furniture, for example moving your bed downstairs, and moving other items so you can reach them easily. You may also need some extra help around the house too, so see if a friend or family member can stay with you to support. 

What are the alternatives to toe deformity correction surgery

If you have a toe deformity, your doctor may recommend other treatments before you resort to surgery. These include: 

  • Changing your style of shoe 
  • Wearing padding and toe devices to protect any painful areas on your toes 

If the above treatments are not alleviating your symptoms, you may be referred for surgery.

What happens after toe deformity correction surgery

After your surgery, you’ll need to rest until the anaesthetic has worn off. You may need to take some pain relief. 

You may be asked to wear compression stockings or socks to promote healthy blood flow. You may also need to have an injection of an anti-clotting medicine (or tablets) as well. 

Your foot will be bandaged after the operation and you may have a cast. You will usually be provided with some crutches and a special shoe to wear. You’ll also be given advice on how much weight you can put on that foot. 

You’ll usually be able to go home when you feel ready. This may be about an hour or two after your operation. You may be given a date for a follow-up appointment before you leave. 

If you’ve had a general anaesthetic, ask a friend or relative to take you home. Also ask them to stay with you for a day or two while the anaesthetic wears off. 

Recovering from toe deformity correction surgery

You may experience some discomfort in the following few days and weeks after your operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen.  

To promote speedy and healthy wound healing you should keep your dressing and cast dry. It is recommended that you put a plastic bag over your foot when you have a shower.  

You’ll probably be able to put weight the unaffected foot straight away. However, it’s important to rest with your feet up as much as possible in the first few weeks to help reduce any swelling. 

You may need to wear a cast for four to eight weeks. After this time, you may need to wear a removable boot or walking cast to start putting weight on your recovering foot. You’ll usually need to use crutches to help you get around. 

You should be able to drive again once you are able to do an emergency stop safely and wear normal shoes. However, you should discuss this with your surgeon first. 

How quickly you can return to work will depend on the type of role you have. If you have an active role, involving lots of walking or lifting, you may need to book a few weeks off work. If you have a seated desk-based job and work from home, you may be able to return to work as soon as you feel able to.  

Complications and side effects

Side-effects after your surgery may include: 

These can include:  

  • Recurrence of your hammer toe, mallet toe or claw toe swelling. Swelling is always present after surgery as it is part of the normal healing process. This may last longer than expected or become permanent 
  • A floating toe. This is where your toe may not sit on the ground 
  • Deep vein thrombosis – DVT (blood clots in the leg)
  • An infection, for which you may need antibiotics. 

It may take six months to a year for the swelling to completely go down. 

Contact your hospital or GP if you have: 

  • A high temperature 
  • Worsening pain or pain that doesn’t stop when you take painkillers such as paracetamol and ibuprofen 
  • Redness around your dressing or if it feels warm 
  • Swelling or pain in your calf muscle of your leg 
  • Discharge from your wound. 

FAQs

It is possible to have surgery to treat conditions on both feet at the same time, though this is not recommended, as you won’t be able to walk on either foot afterwards. 

Those who wear high heels and unsupportive shoes are more likely to develop toe deformities. 

Immediately after your operation, you will be unable to walk on the affected foot. You will likely be using crutches and your unaffected foot will be supporting you more than previously. Your surgeon will advise you on which footwear will support your recovery and when you can transition back to your everyday footwear. 

Recovery times differ from person to person. You may be able to walk on both feet again after around eight weeks, or you may need to wear a walking cast or removable boot for some time. It can take three to four months until you can walk well enough to resume your normal activities and plan sport.  

It may take six months to a year for the swelling to completely go down. 

Ways to pay

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