What is hammertoe correction surgery?

What is hammertoe correction surgery?

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Hammertoe correction is a surgical procedure performed to correct hammertoe deformity. Hammertoe is a common toe deformity that affects one or more of the small toes, most commonly the second, third, or fourth toes. It is characterized by an abnormal bending or curling of the toe(s) at the middle joint, resembling the shape of a hammer.

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Hammertoes can develop due to various factors, including wearing ill-fitting shoes, toe muscle imbalances, foot structure abnormalities, and arthritis. Over time, hammertoes can become painful and lead to corns, calluses, and difficulty wearing shoes comfortably.

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Hammertoe correction surgery is recommended when conservative treatments, such as wearing appropriate footwear, using toe splints or pads, and doing toe-stretching exercises, have not provided sufficient relief from pain or when the deformity is severe and significantly affects foot function.

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The surgical procedure involves making a small incision on the top or side of the affected toe at the middle joint. The surgeon may release or lengthen the tight tendons and ligaments causing the toe to curl. In some cases, a small piece of bone may be removed to straighten the toe. Once the deformity is corrected, the surgeon will suture the incision and provide appropriate dressing.

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When would a patient need hammertoe correction surgery?

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Hammertoe correction surgery can benefit individuals who have hammertoe deformities that cause significant pain, discomfort, and functional limitations and do not respond to conservative treatments. The surgery aims to straighten the affected toe(s) and alleviate symptoms associated with hammertoe.

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This type of surgical procedure is considered when a patient experiences the following signs and symptoms:

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1. Chronic Pain: Individuals experiencing chronic pain or discomfort in the affected toes due to the hammertoe deformity may benefit from surgery to relieve pain and improve foot function.
2. Difficulty Wearing Shoes: Hammertoes can cause friction and pressure points, leading to the development of corns, calluses, and blisters on the top of the bent toe(s). Surgery can help alleviate these problems and allow for more comfortable shoe-wearing.
3. Impaired Foot Function: Severe hammertoe deformities can restrict foot movement and affect balance and gait. Hammertoe correction surgery aims to restore toe alignment and improve overall foot function.
4. Recurrent Infections: Hammertoes that rub against footwear can create areas of irritation that are prone to infections. Surgery can address these chronic issues and reduce the risk of infection.
5. Limited Activities: If hammertoes significantly limit a person's ability to participate in sports, physical activities, or daily tasks, surgery may be considered to restore function and improve quality of life.
6. Failure of Conservative Treatments: When non-surgical treatments, such as wearing proper footwear, using toe splints or pads, and stretching exercises, fail to provide relief, surgery may be the next step.
7. Cosmetic Concerns: In some cases, hammertoes can cause visible deformities that affect the appearance of the foot. Surgery can address the cosmetic aspects of hammertoes, restoring a more natural toe alignment.

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It's important to note that not all cases of hammertoe require surgery. Many individuals with mild hammertoes can find relief through conservative treatments and lifestyle modifications. 

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The decision to undergo hammertoe correction surgery should be made in consultation with a foot and ankle specialist or podiatric surgeon. The surgeon will thoroughly assess the hammertoe deformity, medical history, response to conservative treatments, and overall health to determine if hammertoe correction surgery is the most appropriate treatment option for your specific case.

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After hammertoe correction surgery: What to expect

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After hammertoe correction surgery, the recovery process is essential to ensure proper healing and successful rehabilitation. Here's what you can generally expect during the recovery period:

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1. Hospital Stay: Hammertoe correction surgery is typically performed on an outpatient basis, meaning you can go home the same day of the surgery.
2. Dressings and Wound Care: You will have dressings over the surgical site, and your surgeon will provide instructions on how to care for the wound and when to change the dressings.
3. Foot Elevation: Keeping your foot elevated above heart level for the first few days after surgery can help reduce swelling and promote healing.
4. Pain Management: You may experience some pain, swelling, and discomfort in the foot and toes after the surgery. Your healthcare team will prescribe pain medications to manage post-operative pain.
5. Foot Immobilization: Depending on the type of hammertoe correction surgery performed and your surgeon's preference, you may need to wear a special post-operative shoe, surgical shoe, or cast to protect the foot and surgical site during the initial healing phase.
6. Weight-Bearing and Activity Restrictions: Your surgeon will provide guidelines on weight-bearing and activity restrictions during the early stages of recovery. You may need to avoid putting weight on the operated foot and limit certain activities to allow for proper healing.
7. Follow-up Appointments: You will have regular follow-up appointments with your surgeon to monitor your progress, check the healing of the surgical site, and make any necessary adjustments to your treatment plan.
8. Physical Therapy: Depending on the extent of the surgery and your surgeon's recommendation, physical therapy or foot exercises may be prescribed to aid in the recovery process, promote healing, and restore foot strength and flexibility.
9. Gradual Return to Activities: Your surgeon will provide guidelines for gradually resuming weight-bearing and daily activities. Avoid high-impact activities and vigorous exercise until cleared by your surgeon.
10. Footwear Recommendations: Your surgeon will advise you on appropriate footwear that supports proper foot alignment and promotes healing during the recovery period.
11. Scar Management: Your surgeon may recommend scar massage or other scar management techniques to help minimize scarring.
12. Timeframe for Full Recovery: The recovery period varies from person to person and depends on the extent of the hammertoe correction surgery. Most individuals can expect gradual improvement over several weeks to months.

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It's essential to follow your surgeon's instructions diligently and attend any scheduled follow-up appointments to ensure a successful recovery. Adhering to post-operative care guidelines and any prescribed physical therapy exercises will lead to the best possible outcome, allowing you to regain foot function and safely resume daily activities with reduced pain and improved foot mobility.

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How can physical therapy help? 

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Physical therapy plays a significant role in the recovery process after hammertoe correction surgery. A physical therapist will design a customized rehabilitation program to promote healing, restore foot strength and flexibility, and guide you back to your normal activities. Here's how physical therapy can help with hammertoe correction surgery:

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1. Pain Management: Physical therapists use various techniques and modalities such as ice, heat, ultrasound, electrical stimulation, and manual therapy to manage post-operative pain and reduce foot and toe swelling.
2. Wound Care: Physical therapists can assist with wound care and scar management to promote proper healing and minimize scarring.
3. Edema Management: Physical therapists may use techniques such as compression, elevation, ankle pump exercise and lymphatic drainage to manage post-operative foot edema (swelling).
4. Flexibility and Range of Motion Exercises: Early after surgery, physical therapists focus on gentle range of motion exercises such as passive to active range of motion to prevent stiffness and maintain  foot and toe mobility. As the patient improves, manual and self-stretching exercises are prescribed to increase the muscle flexibility and range of motion of the affected foot and toe.
5. Strengthening Exercises: As healing progresses, physical therapists prescribe progressive strengthening exercises to increase foot and toe muscle strength, endurance and performance. This type of exercise may also include toe crunch and picking up objects with the use of the affected toe to improve the grip strength. 
6. Assistive Device: In the first few weeks after surgery, the use of assistive devices such as crutches may be prescribed to help the patient maintain mobility and physical function while considering the weight bearing restrictions.
7. Gait Training: Initially, the physical therapists will teach the patients about appropriate gait patterns with the use of an assistive device and while considering the prescribed percentage of weight bearing allowed. As the patient improves, the therapists will utilize progressive gait training in full weight bearing without the assistive device. Emphasizing appropriate foot mechanics and avoiding  compensatory movements.
8. Balance and Proprioception Training: These exercises will help to improve your joint position sense (proprioception) and control as well as static and dynamic balance, which can be affected after foot surgery.
9. Desensitization Exercises: After surgery, it is common for the affected area to develop increased sensitivity. This may result in discomfort when certain objects touch the area. Desensitization exercises are prescribed to decrease sensitivity by exposing the area to objects with various textures and pressures.
10. Footwear Recommendations: Physical therapists can provide guidance on appropriate footwear that supports proper foot alignment and promotes healing during the recovery period.
11. Gradual Return to Activities: Your physical therapist will guide you in a step-by-step approach to return to weight-bearing and daily activities. Avoid high-impact activities and vigorous exercise until cleared by your surgeon.
12. Patient Education: Physical therapists educate patients about hammertoe correction, its indication and what to expect after surgery as well as the role and importance of postoperative rehabilitation programs. They also teach patients about proper foot care, activity modifications, and injury prevention strategies.
13. Home Exercise Program: A specialized home exercise program is provided by the physical therapists. They also teach patients how to safely and effectively incorporate it into their daily routine to reinforce the intervention and promote optimal recovery.  
14. Progress Monitoring: Physical therapists continually monitor your progress and adjust the treatment plan as needed to ensure a successful recovery.

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Physical therapy is essential to optimize your recovery after hammertoe correction surgery. The therapist's expertise and guidance are instrumental in promoting healing, preventing complications, and helping you regain foot function and mobility. Consistent participation in physical therapy exercises and adherence to your therapist's recommendations will lead to the best possible outcome, allowing you to return to your desired level of foot function and safely resume daily activities with reduced pain and improved foot mobility.

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