Resolving bunions and hammertoes in Adelaide, Elizabeth Vale and Murray Bridge

Footmed Foot and Ankle Clinic provides a variety of quality services to treat bunions and hammertoes. We welcome patients from across Adelaide, Elizabeth Vale and Murray Bridge.

What is a hammertoe?

Hammertoe is a contracture – or a bending – of the middle joint of the second, third, fourth, or fifth toes. The toes have buckled making the top of the joint prominent. This causes rubbing on the joints making them red and painful. Painful corn or callus often develops at these pressure sites. If the toes have been in this position for a long time then arthritis can add to the pain experienced. Hammertoes can also create pressure, pain and callus under the ball of the foot referred to as metatarsalgia.

Hammertoe causes

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to bending of the toe, results from mechanical (structural) changes in the foot that occurs over time in some people. Shoes that don’t fit properly often aggravate hammertoes. In some cases, ill-fitting shoes can actually cause the contracture. A hammertoe may develop if a toe is too long and is forced into a cramped position when a shoe is worn. Occasionally, hammertoe is caused by some kind of trauma such as a broken toe. In some people, hammertoes are inherited and can be due to diabetic myopathy, osteoarthritis and rheumatoid arthritis. Special consideration is necessary when a bunion accompanies a second hammertoe deformity. Bunion correction to minimise the risk of recurrence of the second toe is needed.

Hammertoe treatment

Pads, splints, foot orthoses, anti-inflammatory medication, debriding corns/callus and extra width/depth shoes can be used to provide comfort but is unlikely to straighten the toe. You can also choose to live with the problem. If the hammertoes interfere with daily activities and is affecting your quality of life despite these measures, it’s time to discuss surgical options.

Hammertoe surgery

The most common surgical procedure performed to correct a hammertoe is called an arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint. If the contracture is severe it will require additional release of the joint capsule and tendon further up the front of the foot requiring a longer incision. Digital arthroplasty is always performed for a fifth hammertoe deformity to allow flexibility.

The operation for severe hammertoe deformity requiring joint fusion has been shown to be satisfactory in a number of studies. Those conducted by Coughlin revealed 84% patient satisfaction after 5 yrs and 87% by Alvine & Galvin. This operation (neurectomy) by a dorsal approach has shown good to excellent patient satisfaction rates (78-84%) in two good studies. The Coughlin and Pinsonneault study is a long term follow up after 11 years.

  • Prolonged swelling (sausage toe)
  • Floating toe
  • Infection (smoking increases risk by 16X)
  • Wound problems (slow to heal)
  • Scar sensitivity
  • Nerve Injury (nerves can be bruised which resolves but you can be left with permanent numbness)
  • CRPS = Complex Regional Pain Syndrome (Rare <1%)
  • Deep vein clots

Quite often hammertoes can be performed using a local anaesthetic, so we can reduce the risks associated with a general anaesthetic.

The operation is usually day surgery but you may need to stay overnight. If only 1 or 2 toes need surgery, this may be done under a local anaesthetic in the surgeon’s office. A friend or family member must accompany you after any surgical procedure. The surgeon will discuss this with you. You will be given a stiff soled shoe to wear over your bandages, which you must wear whenever you want to walk. You may begin increasing your activity to tolerance almost straight away and should be able to return to normal footwear in about three weeks. Your bandages need to be kept dry and you will be given an appointment to return to have the foot redressed in one week. You may be able to return to work from 4-6 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. It is often not necessary to correct a hammertoe with screws or wires to keep them straight with the more reliable minimally invasive techniques available.

What are bunions?

Your big toe has turned towards your second toe causing a bony bump to stick out at the side of your foot (bunion). The skin and tissue on the bump of the bunion can become inflamed, swollen and painful. A bunion is more than a ‘bump’; it is a progressive disorder that often involves arthritis of the joint. As the deformity progresses the big toe has moved so far across that it can abut the second toe creating hammertoe deformities. The amount of pain and disability experienced with less severe deformity is similar to a more severe deformity.

Bunion causes

Bunions are most often caused by faulty mechanics of the foot. The deformity runs in families, but it is the foot type that is hereditary, not the bunion. Certain foot types make a person prone to developing a bunion. Injury can be a cause, especially if just one foot is involved. Although wearing shoes that crowd the toes won’t actually cause bunions in the first place, it can make the deformity progressively worse. That means you may experience symptoms sooner.

What does bunion surgery involve?

The operation involves removing the enlarged portion of bone. Ligaments and tendons that are too tight around the joint are released. The metatarsal bone in the big toe is then cut and shifted to a normal alignment that also makes the forefoot narrower. The cut bone is held in place with a screw or wire, which is not removed unless it causes problems. The loose, stretched out joint capsule is then tightened completing the soft tissue balance required for your deformity. Both feet can be operated on at the same time, but this does further limit mobility after surgery.

The operation is usually day surgery but you may need to stay overnight – the surgeon will discuss this with you. You will be given a special sandal to wear over bandages, which you must wear whenever you want to walk. The sandal must be worn for four weeks.

For the first 2-4 weeks we recommend restricted weight bearing of 15-20 minutes to every hour you are awake. When resting, elevate your leg on 2 pillows and take the pain medication prescribed for you. You will be asked to do some foot and knee exercises during this time to stimulate circulation. The bandages will need to be kept dry. You will be given an appointment to return to have the foot redressed in one week. You may be able to return to work from 4-8 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. After 4 weeks you may begin increasing your activity to tolerance using sneaker type footwear, and resting/elevating the foot as required.

The operation has been shown to be predictable and reliable with good to excellent patient satisfaction of 92% after 2 years and 87% satisfaction after 12 years. No other procedures have been shown to be superior to the Chevron osteotomy in the Cochrane review for the surgical treatment of bunions.

  • Swelling (for up to 6-9 months)
  • Infection (smoking increases risk by 16X)
  • Wound problems (slow to heal)
  • Scar sensitivity
  • Nerve Injury (nerves can be bruised which resolves but you can be left with permanent numbness)
  • CRPS = Complex Regional Pain Syndrome (Rare <1%)
  • Deep vein thrombosis (clot in deep vein in the legs)
  • Continuing symptoms (if the toe still remains a problem, other surgical options may need to be considered)

Following surgery allow the foot a good 12 months to fully settle down. The surgeon will explain any particular individual risks that you may have.

Learn more about treating bunions and hammertoe.

Call 08 8342 3131.08 8342 3131.