OP of hammer toes

Introduction

The hammer toe is a permanent, claw-like flexion of a toe, which occurs especially in the first toe joint close to the metatarsus. Hammer toes are the most common deformation of the foot and affect many people. The severity of the condition has a significant impact on the symptoms, treatment options and level of suffering of those affected. In early stages of hammer toes, conservative therapy using barefoot walking, special orthopedic insoles or physiotherapy can have promising results.

Indication

Conservative therapy can effectively counteract the onset of flexion of the toe joints and, in early stages, stop progression of hammer toes and even correct the toe position. If a therapeutic success is not possible with conservative treatment, various surgical interventions can be used. The individual indication for surgical treatment must be determined jointly by the physician and patient, taking into account the prospects of success, the patient’s situation, the level of suffering and the symptoms. Protracted conservative therapies are not advisable, especially for young, athletic patients and those with severe symptoms. In addition to the pain caused by the hammer toe, the decisive symptoms include calluses, problems with footwear and in everyday life, as well as aesthetic complaints.

These OP methods are available

There are primarily two surgical methods available for the correction of hammer toes. The surgical procedure can generally only be performed if there are no risks, for example, problems with anesthesia or severe circulatory problems in the leg. The most important distinguishing feature for the choice of a surgical method is a contracture of the tendons in the hammer toe.

If the examination shows that the deformity is tight and cannot be straightened manually, Hohmann’s surgery is recommended. Flexible malalignments, on the other hand, should be approached with the operation according to Weil. Hohmann’s operation is the most extensive procedure and is only performed when a so-called fixed hammer toe is present.

In the course of time, the permanent flexion of the toe joints can lead to shortening of the tendons. The soft tissues of the toes can also shorten and lead to contractures. In these cases, a simple rearrangement of the tendons is no longer possible, so that the head of the metatarsophalangeal joint of the toe must be removed from the bone during the Hohmann operation.

The contracted tendon is then stretched and, if necessary, detached from the bone. Such an operation is known as an “osteotomy”, a repositioning of the bone, which is only used when all conservative and gentle surgical procedures are of no further help and the hammer toe is completely irreversible. The operation according to Weil represents the gentler variant in the treatment of hammer toes.

However, it is only possible with the so-called “flexible” hammer toe. This is referred to when the hammer toe can be easily returned to its original position. This means that there are no fixed contractures of the tendons and soft tissue.

The Weil operation also involves cutting through the toe bones, but these are only advanced to change the position of the toe. The metatarsophalangeal joint of the toe remains intact. Here too, the tendon is subsequently lengthened.

The displacement of the bones is fixed with small screws, which can remain in the body. The insertion of a wire to fix the hammer toe is a common variant of the Hohmann operation. In particularly tight contractures, the toe must be supported with a wire for a few weeks.

The wire serves as an internal splint so that the toe does not fall back into its original position after the operation. For this purpose, the wire can be inserted intraoperatively along the toe and remains there for about 2-4 weeks until the hematomas and swellings caused by the operation have subsided and the bone has had time for primary healing. During this period, the toe is difficult to move and should first be taped, splinted externally and immobilized.

Physiotherapy can only be started after the wire has been removed. The wires can be inserted in different places to splint the toe. They can only run through the soft tissues, which makes removal much easier.

Less frequently they are also fixed in the bone, which is associated with a perforation of the bone and joint, as well as a more difficult removal. After a period of 2-4 weeks, which is determined by the surgeon, the wires can be removed without anesthesia.As a rule, this is a very short and painless process, so even an anaesthetic would not bring any advantages. An important indication to remove the wire immediately is possible redness, overheating and sensitive pain at the point of wire exit.

This can be a local inflammation. In rare cases, removal may also be complicated by wire migration. Due to healing processes in the bone and soft tissues, the wire can be displaced and anchored, so that in rare cases simple removal without anesthesia is not possible.

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