WHAT TO EXPECT WITH HAMMERTOE SURGERY
Many patients considering hammertoe surgery have come into contact with other individuals who have already gone through the process and have shared their experiences, some good and some bad. As a physician it is my job to explain the process of having bunion surgery on a daily basis and regularly explain how it is very difficult in comparing apples to apples when it comes to bunion surgery. There are many different variables regarding bunion surgery as it relates from one patient to the next and hopefully the following can help answer your questions if you are deciding on having bunion surgery in the future.
The best time to have corrective surgery for painful hammertoes is if after conservative treatment such as shoe modifications and orthotics have failed to give any relief and the pain has begun to affect your activities of daily living. Only one foot is operated on at a time to enable patients with one good foot to walk on, ensuring a safer recovery.
There are a variety of different procedures and techniques that are available to correct hammertoes and that largely in part is determined by the foot type that you possess and the severity of the hammertoe contractures. Different types of hammertoes based on the location of contractures within the toe as well as the flexibility and reducibility of the contractures will also have an impact on the type of procedure. Other factors that are taken into consideration include age, weight, bone stock or appearance on radiographs, and level of daily activities. The procedure chosen for you will have an impact on your post-operative recovery period including the protective device that you will need, weight-bearing status, and ability to return to your normal shoes and activities. These procedures generally takes less than an hour to complete, are performed under twilight sleep (IV only), and are done in an out patient setting. Due to the IV sedation, you are not permitted to eat or drink after midnight the night before surgery and you are not permitted to drive yourself home after the surgery. Lastly, a prescription for pain medicine and an anti-inflammatory will be given before the surgery and it is recommended that these are filled so that you have these ready after your surgery.
In general, most individuals having hammertoe surgery have a procedure similar to that described in the above video. This procedure essentially releases the contractures in the joint and lengthens the tendon on the top of the toe. This enables the toe to rest in a straighter position. In order to maintain this correction long-term and aid in achieving a more natural appearing toe, the bones of the toe need to be fused or permanently stiffened. This involves removing cartilage off of the adjacent bone surfaces and holding the two bones in a desired position until they heal together as one. There are a variety of implants and techniques used to hold and maintain the toe in the correct position. Traditional methods include the use of a pin that extends out the end of the toe. This is removed in the office typically between four and six weeks after surgery. Newer techniques and implants, such as the new Arrowhead implant, allow for the implant to be buried within the toe and negate the need for a pin to extend out the end of the toe. These new techniques enable patients to return to normal shoes at a faster rate then previously allowed with external protruding pins.
Absorbable sutures are used to eliminate the need for removal afterwards and are buried underneath the skin to give more of a cosmetic scar during the healing process. When the surgery is complete, a post-operative block is administered around the surgical site to yield numbness and a painless recovery and return home. Even thought it is sometimes typical for the local anesthesia to render numbness to the foot until the following morning, I recommend that you begin using your pain medication around dinnertime the night of your surgery. Ice, foot elevation on a pillow, and rest will all help to aid in a smooth recovery after your procedure.
The post-operative course for this surgery includes a sterile dressing and protective shoe or walking boot. The dressing is not to be changed or tampered with until seen by your doctor one week after surgery and is not to get wet. Patients are permitted to walk on the operative foot as tolerated immediately after surgery, however, it is important to keep the foot dry for the first two weeks. At two weeks after surgery, all bandages are removed and patients are permitted to wet the foot while bathing. It is at this point that patients can transition back to a supportive athletic shoe as tolerated. If the toe(s) were stabilized with pins that extend out the ends of the toe(s), patients are to continue with the surgical shoe until the pins are removed. In general, I advise individuals to decrease their normal activities for six weeks as post-operative pain and swelling is correlated to patient activities. Although everyone heals at a different rate, in some cases swelling can occur for up to a year after surgery. Patients are advised to take a minimum of one week off from work to recover from the anesthesia and the procedure.
IF YOU ARE CONSIDERING SURGERY FOR YOUR HAMMERTOES, CALL TODAY TO FIND OUT MORE ABOUT YOUR OPTIONS: 770.979.0900
HAMMERTOE SURGERY: BEFORE & AFTER