Toe deformity correction surgery

There are some visible symptoms that suggest you might need toe deformity correction surgery – the most obvious one being an abnormal bend in the joints of one or more of your toes, causing them to stick up rather than forward. Other symptoms could include:

• Hard skin (callus) that forms over the affected joint or at the end of your toe
• A deep blister (bursa) that forms over your joint and becomes inflamed
• Inability to move your affected toe
• Pain on the prominent joint that sticks up or between your toes
• Swelling and/or redness
• Discomfort when walking or wearing certain shoes

The muscles in your toes work in pairs to straighten and bend. If your toe is bent in one position for long enough, as is the case when you wear shoes that don't fit properly or are high heeled, the muscles become weaker. Eventually, they tighten and cannot stretch out properly, meaning they no longer have the ability to straighten your toe. When this happens, your affected toe assumes a permanently bent position and looks like either a claw or hammer.

There are two distinct types of deformed toes: flexible and rigid.

Flexible

In the early stages of a toe deformity, your joint is still moveable. If you have a flexible deformed toe, it is possible that the problem can be treated without surgery. You might just need to switch to better shoes with more room and avoid wearing high heels and tight shoes. Toe-strengthening exercises may also be recommended, along with padding to prevent rubbing and ice packs to reduce pain and swelling.

Rigid

Over time, your joint becomes rigidly stiff, making it extremely difficult to move. This occurs when too much pressure is placed on your toe muscles over a prolonged period, causing the muscle to weaken and lose its ability to straighten out the toe. There are ways to relieve the pain, such as changing shoes or wearing a custom brace. If you have a rigid deformity in your toe and these conservative methods don't work to correct it, your consultant may recommend surgery.

Along with wearing shoes that place high levels of strain on your toe muscles, toe deformities can develop due to specific conditions, including:

Rheumatoid arthritis

This condition can lead to damage to the joints in your foot, increasing instability in this area and potentially causing a toe deformity to develop.

Diabetes

Chronic nerve damage as a result of diabetes, or a muscle imbalance of some kind, can bring about poor foot mechanics and, by extension, a deformed toe.

If you have either of these conditions as well as a deformed toe, we will most likely look to treat these original conditions first before suggesting toe deformity correction surgery.

When you meet with your consultant, they will ask some questions about your toe deformity, such as:

• How long the problem has been present for
• What symptoms you have
• Whether you've had any toe deformity treatment in the past

They will then perform a physical examination of your toe, checking to see if the joint is flexible or rigid, which helps them decide on the right treatment for you. It could be that they order an X-ray to gather further information about the bones and joints in your feet and toes and confirm the diagnosis.

If you have diabetes or reduced sensation in your feet, your consultant may ask for further testing, as it could be that the tendon imbalance is due to a neurological condition (disorders that affect the brain and nerves).

In most cases, your consultant will initially recommend non-surgical treatment - especially if you haven't tried any yet. This could include:

• Changing to roomier, more comfortable footwear
• Wearing shoe inserts or pads, which can reposition your toe and relieve pressure-related pain
• Exercises that encourage stretching and strengthening toe muscles (e.g., picking up marbles or crumpling a towel with your toes)

If these conservative treatments don't make a difference, or if you've already tried them to no avail, your consultant may recommend toe deformity correction surgery.

There is no specific preparation for foot surgery, however there are things you can do to be as prepared as possible:

Stock up on supplies

Although you'll be able to put some weight on your foot immediately after your toe deformity correction surgery, we recommend that you rest as much as possible. You will also need to wear a special boot as your toe heals, which means your mobility will be limited and you won't be able to make quick trips to the shop.

So, ahead of surgery, take some time to gather all the supplies you need for a week or so. If you need anything else as you're recovering at home, ask a friend or family member to get it for you.

Rearrange your home

Given that you'll want to limit your movement as much as possible for the first week or so after surgery, you might need to make some adjustments to your home in advance. If you sleep on the second floor, for example, we recommend you set up your rest area on the ground floor, meaning you won't have to climb stairs as you heal. You should also remove any potential tripping hazards from your recovery space at home.

Medication

Prior to your toe deformity correction surgery, your consultant will review medications with you. It could be that they ask you to stop take any 'blood thinning' medications - aspirin, anti-inflammatories, warfarin, etc. - about two weeks in advance to reduce the chance of unwanted bleeding during and/or after the surgery.

Food and drink

Take care to eat healthily and drink plenty of water prior to your surgery. You should also stop drinking 48 hours ahead of coming to the hospital.

Stop smoking

To reduce the chances of complications during and after surgery, we recommend you stop smoking at least two weeks before you receive toe deformity correction surgery. Smoking can negatively influence your breathing before and/or after surgery, along with hampering your overall recovery. There is also an increased chance of blood clotting after surgery for smokers. If you need help with smoking cessation, or have any other questions, get in touch with your consultant.

Toe deformity correction is a day surgery, which means you'll be able to go home on the same day of your operation. The procedure is generally performed under local anaesthetic. This is when your surgeon injects an anaesthetic into the affected area to make it feel numb, so you won't feel anything, nor will you see the operation taking place.

The exact kind of toe deformity correction procedure your surgeon chooses will depend on the type and extent of your deformity. If your toe is flexible, for example, treatment may differ compared with deformities that have gone rigid. There are three main forms of toe deformity correction: tendon transfer, joint resection, and fusion.

Tendon transfer

Due to the way tendons attach muscle to the bone, they can be used to compensate for your deformed toe's weakness and improve its appearance.

This particular treatment is generally used in cases of flexible toe deformities, and involves your surgeon making an incision at the top of the toe. Through this incision, they will locate the tendon, moving and placing it across the top of the joint that has been weakened over time, which pulls the toe into a straighter position and gives it more strength.

Joint resection

Your surgeon will make an incision at the top part of your toe so that they can access the ligaments and tendons underneath, which they may cut to help straighten your toe. They will also remove the end of the bone so that the toe can be fully extended once again. Once the parts of your joint and bone have been cut in a way that allows the toe to be straight again, your surgeon may insert small metal pins to keep the toe in the correct position as it heals. These pins are usually removed a month after your surgery.

Fusion

This treatment might be used if you have a more severe rigid toe deformity, along with issues like bunions (a bony bump that forms on the joint at the base of your big toe) or arthritis within your toe joint. In similar fashion to joint resection, your surgeon will remove a small part of the bone in your toe so that the toe can be fully extended. At this stage they will insert an external wire or pin and/or an internal plate that holds the bones in place, allowing them to fuse together over time. This will mean that your toe is not flexible but ensures that it stays straight as opposed to sticking up.

One to seven days after surgery

If you had toe deformity correction surgery under general anaesthetic, you may feel a bit groggy as you wake up, which is normal as the general anaesthetic wears off. You will be given a couple of hours to rest before we make the appropriate arrangements to send you home. If you had the procedure under local anaesthetic, you won't feel groggy, but there is a possibility you will feel some pain. If you do, we will provide adequate pain relief, along with supplying you with medication to take as you recover at home.

After surgery, we will provide you with special footwear that ensures your toe heals correctly, along with crutches to help you keep the weight off your foot. For this first week, keep your foot elevated and iced as much as possible, especially for the first 48 hours, as this will speed up healing and reduce your pain levels. You should avoid getting the wound wet for the first week, so take care to carefully wrap your foot in a plastic bag before you shower.

One to four weeks after surgery

If you have a sedentary job, you can return to work between one and two weeks after your surgery. However, it might be more like six weeks before you can start working again if your job requires being active and on your feet. If the surgery took place on your right foot, you probably won't be able to drive until around the four-week mark.

After two weeks, you can gradually return to normal walking, but please check with your physiotherapist first. You will be advised to walk on your heel for these first few weeks and avoid putting pressure through the whole foot. You may be able run through some range of motion exercises set for you by your physiotherapist during this time if they think it's appropriate. You will still have some pain and swelling after a few weeks, so it is important that you take it easy and don't push yourself.

One to three months after surgery

Any pins or wires that were used during surgery to straighten your toe can be removed after four to six weeks. You will also be able to return to normal footwear. Hammer toe can be a recurring problem, so be careful to wear shoes that are spacious and comfortable to avoid encountering the same issue again. You should be able to put full weight on your foot after around a month, although you might be able to do this sooner.

During this period, your physiotherapist will begin to run you through more advanced exercises that increase the strength in the toe and foot muscles, which in turn helps the toe to heal, along with reducing the chances of hammer toe or claw toe coming back.

These exercises might include stretching your toe, foot, and calf, bringing your toe and foot back to their normal position and stretching out any muscles that may be pulling on the toe and causing strain. Your physiotherapist may ask you to use exercise bands, or simply press your toes flat on the floor, along with making sure you are walking with a proper gait. This is particularly important, as walking inefficiently can potentially cause further pain or problems in your foot and elsewhere.

Toe deformity correction is an extremely safe and straightforward surgery. Complications can occur, but these are very rare. Your consultant will explain the entire process to you beforehand, including any risks, and respond to your questions and/or concerns, so you can make a fully informed decision.

H3: General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Feeling sick
• Shivering and feeling cold

Complications of general anaesthetic

• Difficulty passing urine
• Chest infection
• Heart attack or stroke
• Temporary confusion or memory loss
• Dizziness

Specific complications of toe deformity correction

• Prolonged swelling (more than six months)
• Haematoma (pain accumulation of blood within the operation site)
• Adverse reaction to painkillers
• Delayed healing of your wound
• Impaired circulation
• Chronic pain syndrome (nervous system dealing with the pain overreacts over a prolonged period)
• Infection of the bone
• Recurrence of hammer toe and continued pain after surgery
• A stiff or floppy toe
• Nerve damage
• Avascular necrosis (where part of the bone in your foot loses its blood supply, leading to problems like arthritis in the joint)

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your schedule
• The autonomy to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans adapted to your precise needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Hammer toe deformity: soft tissue correction, Orth Oracle
2. Hammer toe surgery: what to expect, MedicalNewsToday
3. Hammer toe, OrthoInfo