Is Hammer Toe Surgery Painful?

A hammer toe is a deformity in which one of your toes bends downwards instead of forward, so it resembles a hammer. You may experience pain, swelling and redness after surgery.

Hammer toe (or hammertoe) is a deformity in which one of your toes bends to point downward instead of forward, resembling a hammer. The middle joint curls to point upward, and the end of the toe curls under. It can happen to any toe but it most frequently occurs in the second or third toe. 

The primary symptom of hammer toe is the upward bend in the middle toe joint. Early on, you may be able to straighten the toe out to its normal position. Over time, however, the toe becomes stiffer and less able to return to a typical position. This can lead to pain with walking, or the formation of blisters, calluses, or corns.

Hammer toe is typically caused by wearing shoes that are too narrow or tight, like pointed high heels. Children can also develop hammer toe if they wear shoes that are too small. 

Other causes of hammer toe include an injury, arthritis, genetics, diabetes, and age. While you can get hammer toe at any age, it is more likely as you get older.

Your doctor will diagnose hammer toe with a physical examination of your foot.

In certain cases, your doctor may take an x-ray of your foot to further understand the bone positions. If you have any loss of sensation in your foot, your doctor may also perform tests to assess the nerves in your foot and toes. 

Hammer toe is a progressive condition, which means that it will continue to get worse without medical intervention. It is not something that will heal up on its own.

Nonsurgical treatment

If your doctor diagnoses hammer toe early, when you still have a significant amount of flexibility and movement in your toe, they may suggest non-surgical treatment. These approaches can straighten a toe that is starting to bend and help change the way that weight is distributed across your foot.

These options include:

• Non-steroidal Anti-Inflammatory Drugs (NSAIDs) to reduce pain and swelling
• Over-the-counter pads and cushions to reduce foot and toe pain
• Orthotic shoe inserts to redistribute pressure
• Exercises or therapy to increase muscle tone and balance
• Steroid injections into the affected joint to decrease inflammation

Your doctor may also suggest a change in shoes. Wearing shoes that are the right size and that offer some space for movement in the toe box (the part of shoes that protects the toes) can alleviate the pressure that worsens hammer toe.

Hammer toe surgery

If non-surgical options are not effective, or if your hammer toe is very stiff or painful, your doctor might recommend surgery. Depending on the specific factors causing your hammer toe, surgery may take a different approach. A surgeon will usually perform hammer toe surgery with a local anesthetic. You should be able to go home the same day.

One surgical option for hammer toe is tendon lengthening. In this procedure, a surgeon lengthens the tendon in the affected toe (or toes) to provide more flexibility.

Another option is called a tendon transfer. This procedure involves moving part of a tendon from the bottom of the toe to the top to provide more flexibility and movement in the toe.

A third surgical procedure is called arthrodesis (joint fusion). Your doctor may place metal pins or screws in your toes during the surgery, which they will need to remove a few weeks later. This surgery fuses, or internally immobilizes, the toe joints to create more stability and allow for bone growth.

Hammer toe surgery recovery

Though most people can bear weight on their foot immediately after hammer toe surgery, total recovery takes between 4 and 6 weeks. You will likely need to wear a special shoe or boot. Your toe and foot will have some redness, swelling, and pain after surgery.

Some hammer toe surgery is more extensive, and you may need crutches or a wheelchair afterwards. Be sure to ask your doctor about how to best limit your activities to let your toes heal.

If you have stitches, screws, or pins that your doctor will remove later, you may not be able to get your foot wet while bathing or swimming. If your surgery is on your right foot, you may not be able to drive for a few weeks.

If your doctor places pins during your surgery to keep your toes straight while they heal, they will remove them 2 to 3 weeks after the surgery. Removal is usually not painful because the pins begin to loosen on their own during your recovery.

Keeping your foot elevated after hammer toe surgery can help minimize swelling and pain in your foot. Your doctor may prescribe pain medicine or recommend a certain kind of over-the-counter medication for pain management. Ice packs or cold compresses may help minimize swelling and pain, too.

All surgery includes risks of complications. Complications to hammer toe surgery are not common, but you should discuss them with your doctor. The possible complications and side effects of hammer toe surgery are:

• Reaction to anesthesia
• Infection
• Damage to nerves or blood vessels
• Bleeding
• Blood clots
• Loss of stability in the toe
• Bones that do not heal after fusion

Most hammer toe surgery is successful, but your hammer toe may return after surgery. If this is the case, your doctor will again consider non-surgical interventions, or possibly a second surgery.