Hammer Toe Surgery

Hammer toe surgery corrects a deformity where one or more toes bend abnormally at the middle joint. The procedure realigns the affected toe by adjusting tendons and bones, restoring normal position and function. It is performed on any toe except the big toe, with techniques chosen based on severity and flexibility.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus) | MMed (Singapore) | MRCS (Glasgow) | FRCSEd (Orth)

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Hammer Toe Surgery

Hammer toe surgery may be considered when non-surgical treatments have not provided sufficient relief.

Persistent Pain and Discomfort: Pain at the bent joint or pressure from footwear can make daily activities like walking, standing, and wearing shoes increasingly uncomfortable.
Failed Conservative Treatment: Non-surgical methods such as padding, splinting, or toe exercises have not improved symptoms over 6-12 months.
Progressive Deformity: The toe becomes increasingly rigid and bent, making movement uncomfortable and affecting shoe fit.
Skin Problems: Recurring corns, calluses, or open sores develop on the affected toe due to friction against shoes, leading to potential infection risks.

Benefits of Hammer Toe Surgery

Hammer toe surgery offers several advantages for patients dealing with persistent toe deformities.

Pain Relief

By correcting the bone and soft tissue issues causing discomfort, the surgery eliminates pressure points, offering long-term relief.
Improved Toe Alignment

The surgery straightens the affected toe, allowing it to lie flat and function correctly when walking or standing.
Better Shoe Fit

Correcting the toe position allows for wearing regular shoes comfortably without the need for special modifications or footwear.
Enhanced Mobility

Once the toe can bend and straighten properly, walking feels more natural, and your gait improves.

Surgical Techniques

Flexor Tendon Transfer

This technique involves rerouting the tendon responsible for bending the toe to the top, which helps release the contracture and restore proper alignment. By rebalancing the forces on the joint, the transferred tendon supports the corrected position for long-term stability.

Joint Resection (Arthroplasty)

Part of the toe joint is removed to allow straightening. Damaged bone and cartilage are extracted, and tight tendons and ligaments are released. This creates space for the toe to straighten while still retaining some flexibility in the joint.

Joint Fusion (Arthrodesis)

The bones on either side of the affected joint are permanently connected using pins, wires, plates, rods or screws to fuse the bones. This technique straightens the toe but eliminates motion at the treated joint, providing long-term stability and preventing deformity recurrence.

Preparing for Surgery

Medical Assessment: A thorough evaluation is conducted, including blood tests, heart function tests, and chest X-rays to ensure overall health. Our surgeon will also review your medical history, current medications, and any prior foot surgeries to create a personalised surgical plan.
Medication Management: Certain medications, such as blood thinners, may need to be adjusted or temporarily stopped before the surgery. Anti-inflammatory medications should be discontinued as per pre-operative guidelines to reduce the risk of bleeding.
Fasting Guidelines: Fasting is required for 6–8 hours before surgery. Clear fluids may be allowed up to 2 hours before the procedure, depending on anaesthesia protocols.

Step-by-Step Procedure

Anaesthesia Administration

Local anaesthesia numbs the foot, while regional anaesthesia blocks sensation below the knee. General anaesthesia may be used for complex cases or multiple toe corrections, depending on the procedure and individual needs.

Surgical Site Preparation

The foot is thoroughly cleaned with antiseptic and covered with sterile drapes. The surgical team will confirm the correct toe and procedure before making any incisions.

Incision and Exposure

A small incision is made on the top of the toe. Soft tissues are separated to access the joint and tendons while preserving surrounding structures.

Deformity Correction

Depending on the chosen technique, bones and soft tissues are adjusted. This may involve bone reshaping, tendon repositioning, or securing internal fixation devices for stability.

Closure and Dressing

The incision is closed with sutures, and sterile dressings are applied. A post-operative shoe is provided to protect the surgical site and maintain the proper alignment of the toe during healing.

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Post-Surgical Care and Recovery

Immediate Post-operative Care

Keep the foot elevated for 48–72 hours to reduce swelling. Apply ice packs as directed and follow medication schedules for pain control and infection prevention.

Activity Restrictions

Limit weight-bearing for 2–4 weeks, using mobility aids if necessary. Keep the surgical site dry until sutures are removed.

Rehabilitation and Follow-up

Toe exercises typically start at 4–6 weeks after surgery to improve flexibility. Patients can gradually transition to regular footwear by 6–8 weeks, and full recovery may take 10–12 weeks, with follow-up appointments to monitor healing progress.

Potential Risks and Complications

As with any surgery, risks include infection, bleeding, or reactions to anaesthesia. Possible complications may involve stiffness in the toe, delayed bone healing, and ongoing swelling. Some patients may experience numbness around the surgical area or pressure shifting to nearby toes. In some cases, the toe may not fully straighten or could gradually return to its previous position. Though rare, deep vein thrombosis (DVT) is a potential risk, with preventive steps in place. Nerve injury, while uncommon, could result in temporary or permanent sensory changes.

Frequently Asked Questions (FAQ)

Can hammer toes recur after surgery?

Recurrence is possible, especially if underlying foot mechanics (such as flat feet or tight tendons) are not addressed. Wearing appropriate shoes and following rehabilitation guidelines reduces the risk of recurrence.

Can hammer toe surgery be performed on both feet at the same time?

Yes, but recovery may be more challenging due to limited mobility. Some patients prefer to undergo the procedure in stages, treating one foot first to make recovery easier and more manageable.

What happens if a hammer toe is left untreated?

Over time, an untreated hammer toe may become more rigid and painful, making walking and wearing shoes difficult. Persistent friction can lead to corns, calluses, and ulcers, increasing the risk of infection.

Dr. Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A distinguished Senior Consultant Orthopaedic Surgeon specialising in both adult and paediatric orthopaedic care.

Dr. Chua graduated from the University of Adelaide, Australia, with a Bachelor of Medicine and Bachelor of Surgery. He completed his Orthopaedic Specialist training under NUHS in Singapore in 2017.
In 2019, he was awarded the HMDP award, which enabled him to pursue a fellowship in Foot and Ankle Surgery at Oxford University Hospital NHS Trust in the UK.

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