How many toes do I have

Hammer toe corrections

Important NOTE:
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and concretizations are made as a result of scientific research or adaptation of the guidelines by the medical societies.

Here you will find:

In the course of life, our feet carry us around the globe up to three times - and often in unsuitable footwear. With a lot of movements, the feet are also loaded with multiples of body weight. It is therefore not surprising that foot problems are very common with age, especially among women. Of those over 40, 65% complain of sore feet.
The so-called hammer toe is a very common deformation that is promoted by shoes that are too small and too tight in the front. Due to high heels, the foot also slips forward into the shoe and the forefoot is chronically overloaded. The hammer toe is often associated with other foot deformities such as hallux valgus and splayfoot.
In the hammer toe, the toe is hyperextended in the base joint and bent in the end joint, so that the toe first points up and then (like a hammer) down. Most commonly, hammer toes are found on the second, third, or fourth toe. In pronounced cases, the toes stiffen in the misalignment and several toes can be superimposed.
The deformation of the foot leads to the fact that the shoes press on the back of the hammer toe and the tip of the toe practically digs into the sole of the shoe. This creates mechanical irritation with corns and often inflammation and chronic pain. Then at the latest you should also consider an operation, which in many cases can be carried out on an outpatient basis.

What happens during this procedure?

In the case of still movable (flexible) hammer toes that can still be straightened by hand, it is usually sufficient to sever the shortened tendon and the capsule of the toe joint, lengthen the tendon and move it back to its natural location (joint-preserving operation). Or a joint-preserving tendon deflection operation (e.g. relocation of the flexor tendon to the extensor side) is performed to correct the misalignment.

With so-called fixed hammer toes, the toes can no longer be bent straight from the outside due to shrinkage of the surrounding soft tissue. A somewhat more extensive procedure is necessary here, with the aim of relieving the passive tendon tension by shortening the length of the bones.

Depending on the particular circumstances, the procedure includes repositioning the bones (osteotomy), stiffening the toe joints and / or removing parts of the toe bone.

In the Operation according to Hohmann (Resection arthroplasty) the head of the toe joint is removed and the flexor tendon is stretched. In addition, it may be necessary to loosen the capsule of the metatarsophalangeal joint on the back of the foot.

After the operation, the toe usually has to be fixed in its natural position for 2-3 weeks with a thin wire. The wire is then removed again.

The Operation according to Weil (joint-preserving displacement osteotomy) is mainly performed in the case of dislocations in the area of ​​the metatarsophalangeal joints. A change in the metatarsal area results in a shortening and thus a position correction. In addition, the extensor tendon is lengthened and the capsule loosened. We stabilize the movement of the bone with mini-screws, which usually do not have to be removed again later.

When does the doctor advise you to have this procedure?

In the advanced stage, physiotherapy, manual therapy, splayfoot insoles, padding for pressure points and special shoes can no longer achieve much with a hammer toe, so an operation is always recommended in the event of complaints.

Due to the pain, many patients with hammer toes get used to a kind of "gentle cycle" that causes the least pain. However, this gait pattern can be disadvantageous for the rest of the movement system. The risk of falling can also be increased, especially in older people, which is another argument in favor of timely surgery.
In any case, you should present yourself with a painful hammer toe to the orthopedic surgeon, who will then decide together with you which measures are most promising for you.

Which stunning method is usually used?

The surgical interventions on the foot are performed under general anesthesia (reference: general anesthesia) or spinal anesthesia (reference: spinal anesthesia).

How long does the procedure take on average?

The duration of the procedure depends on the particular measures required.

Who may not be suitable for this procedure?

As long as the foot deformities are not causing any problems, conservative measures such as foot gymnastics, insoles and wearing suitable footwear will usually try to achieve an improvement.

Since hammer toe correction is not a vital procedure, you should be completely healthy at the time of the procedure, otherwise the operation will have to be postponed. Skin infections in the operating area must first be healed.

If the procedure is to be carried out under general anesthesia, the anesthetist will first examine the anesthesia. If the anesthesia would pose too great a risk, it may be necessary to switch to another anesthetic method or to dispense with the procedure. Surgery may not be recommended in patients with circulatory disorders in the legs.

How is the risk to be assessed?

In the hands of an experienced surgeon, it is a low-risk procedure. As with any operation, of course, complications cannot be completely ruled out. Your doctor will explain to you in detail about rare complications such as bone or joint infections, nerve or vascular injuries before the procedure.

When interfering with the foot, there is always an increased risk of thrombosis due to the longer immobilization of the leg during and after the operation. Therefore, you will be prescribed thrombosis prophylaxis in the form of syringes for some time, which you must use according to the instructions.

Despite all the care, it cannot always be prevented that an axis deviation occurs again after the operation. In rare cases, a second intervention is necessary.

What do you have to consider before the procedure?

If the procedure is performed under general or spinal anesthesia, you should stay sober from 10:00 p.m. on the evening before the procedure, i.e. do not eat, drink, smoke or chew gum.
If you regularly take medication for other illnesses, you should inform your doctor in advance, as some medications such as blood-thinning substances should be discontinued a few days before the procedure.
Since you are somewhat restricted in your domestic activities due to the possibly required immobilization, it is advisable to ensure the appropriate care at home before the operation.

What happens after the procedure and what should you watch out for?

Even with outpatient foot deformity surgery, you will remain under observation for some time after the procedure - until you can get up and feel fit to go home. The anesthesia will subside relatively quickly, so that you will soon be responsive again. However, it may take a little longer before you are completely clear in your head again. You should not drive your own car on the day of the procedure, nor should you use public transport on your own. Let family or friends pick you up or take a taxi home.
After the surgery, the pain may temporarily increase, so you may need to take a pain reliever. For the first 48 hours, the anesthetics may still make the foot feel numb and numb, so you should use a walking stick as a precaution.
All joints that are not immobilized should be moved as much as possible. Especially in the early phase, it is advisable to position the affected leg high, to only let the foot hang down for a very short time and possibly to cool it to counteract any swelling. In the first few days you should keep walking to a minimum, after which the walking distances can be increased gradually.

If you have been prescribed physiotherapy, you should perform the corresponding exercises regularly - but this should not cause severe pain. The doctor can only decide on a case-by-case basis, depending on the type of injury and the healing process, when you can put full weight on the injured limb or when any remaining material should be removed.

The right footwear will be important in the future. Until the swelling of the soft tissue has completely subsided (about two months), adjustable sandals or wide trainers with a relatively stiff sole are recommended. Walking barefoot and wearing normal shoes is only allowed after about six weeks. In the future, however, you should avoid wearing high heels and narrow, pointed shoes if possible so as not to jeopardize the health of your feet again.

When does the next doctor's appointment usually take place?

On the day of the procedure, your doctor will tell you when you should come back for the next check-up. In your own interest, you should absolutely keep this appointment.
If you get swelling, severe pain, fever, numbness at home, the bandage is pressing or you notice a blue or white discoloration of your toes, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.