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WHAT IS A HAMMERTOE?

A hammer toe is where the small toes (most often 2nd) become bent.  This can cause rubbing on top or pain on the ball of the foot.  This can lead to difficulty with shoe wear.  This can be caused by an acute injury such as a plantar plate tear or if a fracture heals incorrectly.   Most commonly however, this problem comes on gradually over time.  Most commonly it is associated with a bunion.  

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Often wider shoes, splints, taping and orthotics can manage the symptoms of this problem.  If the problem persists, surgery may be indicated.  Surgery is often combined with another procedure such as a bunion correction.  Hammer toes are sometimes treated on their own only if no other associated problem is present.  Correction can involve many things including shortening of the metatarsal bone, fusion of the PIP toe joint, MTP joint release, extensor tendon lengthening or flexor tendon releases.  Pinning may be required.  At other times, a screw may be used. 
 

HAMMER TOE POST OP INSTRUCTIONS

Often hammer toe surgery is combined with other surgery.  Please refer to the post op instructions for the primary procedure or discuss with Dr. Roberts.

 

FOLLOW UP:

  • First appointment: approximately 2 weeks from surgery, usually at the Burnaby Hospital Fracture Clinic.

  • Prior to your surgery, you should have received dates for your 6 week and 3 months follow up visits. 

  • If you still have concerns at the 6 month mark, you are welcome to call to book additional follow up as needed.

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EXPECTED RECOVERY TIMELINE:

  • Swelling and pain is normal and expected in the first two weeks.  Rest, elevation and pain medication are important to help manage this. 

  • If your pain is severe and you aren't managing with the instructions and pain medication provided, call or go to the Burnaby Emergency Department.

  • Ideally by 3 months following surgery, you are walking not necessarily far, or fast but able to get back to your normal day to day in a more normal shoe.

  • Swelling is normal and not a concern and can last for up to 6-12 months.  Some swelling doesn't always resolve fully.

  • If all is healing well, you can progress your walking and other physical activity as your symptoms allow. 

  • You will not know full recovery (pain, swelling, strength) until 9-12 months following surgery.  

 

DRESSING:

  • You will go home from surgery with a bulky but soft dressing on your foot and ankle and your post operative sandal in place.  This can remain as is until your first 2 week appointment. 

PIN: 

  • Sometimes, a pin is required to hold the toe straight while it heals.  If so, you will see a small plastic ball just above your nail. 

    • If this spins or rotates, you can clean it with alcohol and then spin it back into place. 

    • If it gets pushed in, you can clear it with an alcohol swab then pull it out so its no longer pushing on your nail or skin.  If you're not sure you can contact the office.  jo@drlaurenroberts.com 

    • If it pulls out, DO NOT PUSH IT BACK IN due to risk of infection.  If it comes up a significant amount or all the way, be warned there is a sharp tip of the end.  Use caution, apply a gauze dressing to the toe and contact the office at the nexta available time:   jo@drlaurenroberts.com. If it is after hours/ weekend and you are worried, you can attend the ER department at BH hospital for help but this is usually something that can be addressed non urgently in the next day or so. 

    • When your wound allows it (below), you may shower and get the pin site wet.  Do not soak and rinse clean of any soap residue and pat dry.  

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WOUND:

  • Your wound(s) are closed with sutures, some of which will need to be removed.  

  • Do not get the dressing or wound wet for the first 2 weeks.  To ensure this, a bag should be placed over the let to avoid anything getting wet.  

  • The dressing/splint should remain on until your first appointment.  Do not remove this.  It will be changed at the first 2 week appointment

  • Sutures are removed typically at the 2 week mark. Its not uncommon if you have a fair amount of swelling, to have them removed at 3 weeks.  

  • After your sutures are removed, you can shower 2-3 days later and allow clean water to run over the wounds.  Pat this dry and reapply a dressing if it is your preference. It is not required.  The steristrip tapes on your wound can get wet.  Just pat them dry. 

  • Steristrips should stay on for about 10-14 days usually.  If they fall off prior to this, they do not need to be reapplied.  If they are still on after 14 days, ensure you please remove them yourself. 

  • Do not immerse the wound in a bath, hot tub or pool until the scar is fully healed with no scabs.  This is often 4 weeks. 

  • No lotions or creams should be used until the wound is fully healed, often 4-6 weeks. 

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WEIGHTBEARING 

  • You may not put any weight on your foot until 2-3 weeks from surgery.

  • At the 2-3 week mark, you may begin bearing weight through your heel and progress to normal walking as you feel able. This depends on the pin position.  Exact time when you can start bearing some weight will be noted on your post op handout from Dr. Roberts. 

  • You may start taking your sandal off at night after 4 weeks if you feel able and can wean off it in the day as your symptoms and swelling allow.  

  • At 6 weeks from surgery you can transition to a shoe as able.  Keep in mind some people still have too much swelling at this point to be able to get into the shoes they want just yet.

 

PHYSIOTHERAPY:

  • At the 2-3 week mark, if you feel able, you may begin physiotherapy.  Prior to this due to swelling, wounds and dressings, possibly therapy will be limited.  

  • Dr. Roberts will provide you a custom physiotherapy prescription to help guide your therapist in your recovery. 

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DRIVING:

  • You are not able to drive if you are still taking Opioid (Narcotic) pain medication

  • Left foot surgery: beginning at least 2 weeks post op, once you are able to comfortably remove the sandal/boot while driving.  Contact your insurance for further recommendations.

  • Right foot surgery:  You can drive once you are walking fully in a shoe.

  • Try practicing in a parking lot first to ensure your reaction/strength/motion is adequate 

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FLYING:

  • If possible, you should consider avoiding long haul flights for the first 4-6 weeks from surgery.

  • If you must fly before this there is an increased risk of blood clot.  Try to keep moving on the flight, stay hydrated, avoid alcohol, consider compression socks.  Discuss with Dr. Roberts if you require a blood thinner to keep your risk as low as possible. 

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WORK:

  • You should arrange to be off of work for the first 2 weeks after surgery to allow for rest and recovery.

  • If you are working from home or can get to work safely and work in a flexible seated job, you could return to work after the first week if you so choose, provided you are off opiod (narcotic) pain medication.  You will need to elevate the foot and allow for more breaks. More commonly, most patients take 6 weeks off work. 

  • Any work should be sedentary for the first 8-12 weeks.

  • Typically a return to more physical duties can begin gradually at the 12 week mark from surgery. 

  • You may discuss your return to work plan with Dr. Roberts if you still have questions.

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