Hammertoe is a rather common condition of the foot that causes the toe to turn downward. It’s a deformity that can affect any toe of the foot and if left untreated it will most likely need surgery to correct it. Many previous studies involving the correction of hammertoe focus on the surgical repair of the metatarsophalangeal joint (MPJ) and the toe itself. This has enabled experts to develop improved preoperative planning and surgical management of this common condition.
When the hammertoe’s on the surface, a buckling of the other toes occurs due to an imbalance in the tendons in the foot. Any imbalance between the extensor and flexor tendon will result in a hammertoe. Through extensive research, experts have gained a deeper understanding around the features of hammertoe and how to best correct it.
The first thing to do when examining a patient’s hammertoe is look at how rigid it is. Examine the general foot position and muscle balance and check for any further deformities of the foot. The plantar plate and both the medial and lateral collateral ligaments should also be checked for stability.
Any form of dorsal contracture may be a sign of possible plantar issues and should be investigated further. The best way to check the rigidity of a patient's hammertoe is while they’re in a sitting position. If there’s any divergence when plantar stress is placed on the associated MPJ use a dorsal drawer test to see if the plantar plate is functioning effectively and whether there’s any sign of pain. Check the strength of all surrounding tendons too.
Using X-rays for hammertoes
Hammertoes themselves are hard to assess via X-rays, but they do allow doctors to check the patient’s general foot alignment, medial or lateral deviation, bunion deformity, and the metatarsal parabola. Sometimes the use of an ultrasound may be required in the case of non-standard hammertoe deformities.
The best technique so far for analyzing MPJ is through magnetic resonance imaging (MRI). This enables you to check the MPJ or toes for arthritis, as well as checking the state of the plantar plate and ligamentous structures.
The surgical planning for hammertoes involves more than you think. After the examination and tests have been done consideration needs to be made as to whether just the hammertoe will be operated on or if the MPJ needs looking at too. This then needs to be explained to the patient before surgery and before any consent forms are signed.
Hammertoe surgical equipment
As procedures change over time, so does the equipment needed to carry out the surgery. There are now several hammertoe implants available including:
- a polyetheretherketone (PEEK) single-piece hammertoe implant
- a CrossTIE (CrossRoads Extremity Systems) implant
Once surgery has been carried out and the sutures have been removed, have the patient initiate motion of the toe (s) and MPJ to ensure nothing is too stiff. It’s important to encourage patients to keep the treated toe wrapped and toe separators are used, allowing the swelling to decrease and stability to increase.
Recheck the foot after a period of around four or five weeks and at this point start physical therapy. Have the patient work on tendon strength, range of motion, and toe grip strength. A Coban wrap should be used for around three months when total healing is likely to occur. At around week six the patient may return to wearing a stiff-soled shoe and increase activity levels around week eight.