From the Guidelines
Surgical straightening of hammertoes is not recommended as a primary approach to improve gait and skeletal system, as the current evidence suggests alternative treatments such as digital flexor tendon tenotomy or orthotic interventions should be considered first. The most recent guidelines on the prevention of foot ulcers in persons with diabetes, updated in 2023, suggest considering digital flexor tendon tenotomy for treating non-rigid hammertoes with nail changes, excess callus, or pre-ulcerative lesions to help prevent foot ulcers 1. This procedure may reduce the risk of ulcer development and is considered a valuable option for patients who have failed to respond to non-surgical treatment.
When considering surgical options, it is essential to evaluate the individual's overall foot health, including the presence of diabetes, poor arterial supply, and potential for non-healing of surgical incisions 1. The guidelines also recommend prescribing orthotic interventions, such as toe silicone or semi-rigid orthotic devices, to help reduce excess callus on the toe. These alternatives should be considered before opting for surgical straightening of hammertoes, as they may provide similar benefits with fewer risks.
Key considerations for treatment include:
- Evaluating the severity of symptoms and impact on daily activities
- Assessing the effectiveness of conservative treatments like orthotics and proper footwear
- Considering the potential benefits and risks of digital flexor tendon tenotomy or orthotic interventions
- Discussing the potential for adverse effects, such as transfer lesions or non-healing of surgical incisions, with the patient 1.
Ultimately, the decision for treatment should be made on a case-by-case basis, taking into account the individual's unique needs and circumstances, and prioritizing the most effective and safest approach to improve gait and skeletal system function.
From the Research
Surgical Straightening of Hammertoes
- Surgical straightening of hammertoes can improve gait and skeletal system by addressing the deformity and imbalance in intrinsic and extrinsic muscle function across the interphalangeal joint and metatarsophalangeal joint 2
- Proximal interphalangeal joint arthrodesis is a common operative method for treating hammer toe, which can provide less painful and more reliable fixation, as well as equal outcomes compared to other operative techniques 2
- Patient satisfaction rates after proximal interphalangeal joint arthrodesis are high, with pain relief in up to 92% of patients and rare complications 2, 3
Gait Improvement
- Surgical correction of hammertoe deformity can lead to improvement in gait by restoring the normal biomechanical and radiographic parameters of the foot 4
- Subtraction osteotomy of the proximal phalanx neck is a technique that can provide considerable correction and restoration of the biomechanical and radiographic parameters, with an adjunctive advantage of preserving the integrity of the proximal interphalangeal joint 4
Skeletal System Improvement
- Arthrodesis of the proximal interphalangeal joint can provide a more predictable toe posture and reduce the risk of recurrence 5
- The use of intramedullary devices can avoid the complications associated with K-wires, such as exposed hardware and pin removal 5, 3
- Permanent internal fixation options can provide a more natural appearance to the toe without the need for secondary surgical procedures for pin removal 3