A hammertoe is a toe that’s abnormally bent at its middle joint, so it looks like a hammer shape. Typically, it refers to the second, third, or fourth toes. A mallet toe is when just the end joint is bent (like a mallet), and a claw toe is when both joints are bent and the toe kind of curls under. For simplicity, we’ll say “hammertoe” to cover these flexed toe deformities.

Hammertoes often start flexible (you can still straighten them if you push) and then become rigid over time as the tendons and soft tissues contract. They commonly cause corns or calluses on the top of the toe (where it rubs the shoe) or at the tip of the toe (if it’s curled downward). They can also cause discomfort in the ball of the foot because of altered pressure.

Causes: The usual culprits include improper footwear (tight, narrow shoes cramming the toes), muscle/tendon imbalance (often from a biomechanics or arch issue), and sometimes injury or arthritis. There’s a genetic predisposition, too – if your foot shape or mechanics encourage toe buckling, it might happen. Often, hammertoes accompany bunions: as the big toe deviates, it crowds the second toe, pushing it up into a hammertoe. Neuromuscular conditions or diabetes can also lead to clawed toes.

Conservative care means switching to roomy shoes (no more pointy heels), using pads or toe splints, and addressing any underlying issues like flat feet with orthotics. These can relieve pain and slow progression. But once a hammertoe is fixed and rigid, the only way to truly straighten it is with a procedure.

Traditionally, hammertoe correction often meant an open surgery: an incision on top of the toe, remove part of the bone (joint resection or fusion), then often stick a steel pin (K-wire) down the toe to hold it straight for weeks. While effective, that pin sticks out of the tip of the toe, needing vigilant care and making shoe-wearing impossible until removed (usually ~4-6 weeks later). Needless to say, it’s not fun.

Enter Minimally Invasive Hammertoe Surgery: using tiny incisions and percutaneous techniques, we can straighten the toe without the big cut or the ugly pin externalization. Often, we use internal implants (tiny hidden devices) or even no hardware to maintain correction, meaning no pins sticking out in many cases. Recovery is faster and more comfortable, and cosmetically, there’s barely a trace.

There are a couple of minimally invasive approaches, depending on the toe’s condition:

• Percutaneous Tenotomy & Capsulotomy: If a toe is still somewhat flexible, we can sometimes correct it by simply releasing the tight tendons and joint capsule through a tiny stab incision (tenotomy). This lets the toe relax into a straight position. Often combined with a temporary splint or special tape to train it straight while it heals. This is quick and has minimal downtime – good for mild deformities or for older patients who want a very low-impact procedure.
• Minimally Invasive Arthroplasty/Fusion: For a rigid hammertoe, we usually need to address the bone alignment. MIS technique involves tiny incisions on the toe, using small burrs or cutters to remove a piece of the bone at the contracted joint (usually the PIP joint – middle of the toe). Removing a small piece of bone frees the toe to straighten. Now, we need it to heal in a straight position. We use taping or a removable pin that we take out after a few weeks (but even if we use a pin, in MIS, we can often bury the head of it so it’s not sticking out, catching on things). The choice depends on the toe stability and the surgeon's preference. Dr. Patish often opts for no pin, which patients greatly appreciate.
• Combo with Bunion or Others: Many times, hammertoes occur with bunions or other issues. We can tackle multiple in one go, all minimally invasively. For example, fix the bunion and the hammertoe in one surgery (we did that often, and MIS techniques make it quite efficient).

It’s usually done outpatient, often with local anesthesia (toe numbing) plus sedation, similar to bunion surgery if combined. If it’s just one or two hammertoes, some patients even do it wide-awake with local (because sedation sometimes isn’t needed for something quick and virtually painless like a simple tenotomy). We’ll discuss what’s best for you.

• Tiny Incisions: We make one or two very small incisions (2-3mm) around the affected toe joint. Through these, we insert our fine instruments. If releasing a tendon, a small blade does the job via a poke – no stitches needed often. If doing bone work, a tiny burr (like a mini drill) goes into remove the piece of bone. Because the incisions are so small, we usually don’t even need sutures – a Steri-Strip or a single absorbable stitch might suffice. Correction: Once the tight soft tissue is released and the bit of bone causing the contracture is removed, the toe can be straightened. We then implement the fixation, which could be internal. For example, for a second toe hammertoe, we might insert a small implant that locks the two bone ends together to fuse the joint straight.
• Dressings/Splints: After, we often buddy-tape the toe or apply a special splint to hold it in proper alignment during initial healing. If an internal device is used, it’s already stable, but we still protect it. A stiff-soled post-op shoe is worn to prevent too much bending of the toes for a few weeks. Because there’s minimal tissue trauma, usually there’s not a ton of swelling, but we still advise elevation and icing to control it.

It’s usually done outpatient, often with local anesthesia (toe numbing) plus sedation, similar to bunion surgery if combined. If it’s just one or two hammertoes, some patients even do it wide-awake with local (because sedation sometimes isn’t needed for something quick and virtually painless like a simple tenotomy). We’ll discuss what’s best for you.

• Tiny Incisions: We make one or two very small incisions (2-3mm) around the affected toe joint. Through these, we insert our fine instruments. If releasing a tendon, a small blade does the job via a poke – no stitches needed often. If doing bone work, a tiny burr (like a mini drill) goes into remove the piece of bone. Because the incisions are so small, we usually don’t even need sutures – a Steri-Strip or a single absorbable stitch might suffice. Correction: Once the tight soft tissue is released and the bit of bone causing the contracture is removed, the toe can be straightened. We then implement the fixation, which could be internal. For example, for a second toe hammertoe, we might insert a small implant that locks the two bone ends together to fuse the joint straight.
• Dressings/Splints: After, we often buddy-tape the toe or apply a special splint to hold it in proper alignment during initial healing. If an internal device is used, it’s already stable, but we still protect it. A stiff-soled post-op shoe is worn to prevent too much bending of the toes for a few weeks. Because there’s minimal tissue trauma, usually there’s not a ton of swelling, but we still advise elevation and icing to control it.

The doctor will give specific instructions, but here’s a general idea:

• Elevation & Ice: First 2-3 days, keep foot elevated as much as possible. Ice behind the knee or on the ankle to cool blood flow to the foot (since the toe is bandaged). This reduces swelling and pain.
• Weightbearing: Use the provided surgical shoe. Walk on your heel or flat foot (depending on which toes were done; usually, you avoid putting pressure directly on the front of the foot for a couple of weeks). Use a walker or crutches for balance if needed initially. But many find they can hobble around the house carefully right away. Short frequent walks prevent stiffness, just don’t overdo it.
• Toe Position: Keep whatever splint or tape we applied in place until follow-up. It’s crucial for ensuring the toe heals straight. If it slips or loosens, give us a call – we might have you come in to reapply it. Don’t try to bend the toe or test it; trust that it’s in the right spot.
• Pain Management: Around-the-clock mild pain relievers for the first couple of days, even if not terrible (stay ahead of pain). Then taper off. Usually by day 3 or 4, most are fine with just occasional Tylenol.
• Footwear: After the first dressing change, if swelling is down, some patients wear a loose sandal that doesn’t bend (some have stiff soles or a postoperative sandal) to look a bit more “normal.” Always ensure it doesn’t put pressure on the healing toe. Often, patients stick with the provided shoe until cleared for regular shoes. At ~3-4 weeks, a roomy sneaker may be okay if it feels fine and the doc okays it.
• Physical Therapy: Not usually needed for hammertoes. We might give exercises to move the toe once the bone is healed, but often the toe is intentionally fused straight, so minimal motion at that joint is expected (other joints still move). If the toe is a bit stiff at the base, some gentle exercises can help later.
• Activity: Resume driving usually once you’re off strong pain meds and can wear a regular shoe (for right foot, around 2-3 weeks for automatic car if you can manage in surgical shoe carefully, even sooner, but we err on the side of safety). Low-impact activity like stationary biking (with stiff-soled shoes) can start after a few weeks. Running or jumping – wait until around 6-8 weeks when the doc confirms all is good.
• Monitor for Issues: If you notice excessive swelling, redness, or the toe looking misaligned, inform us. With MIS, it’s rare, but better safe. Most follow-ups are just “looks great, see you in a few weeks.”

Hammertoes might seem like a small issue, but they can cause significant discomfort and self-consciousness. Fixing them can dramatically improve your foot comfort and appearance. With minimally invasive techniques, the barrier (fear of surgery) is much lower.

Imagine slipping on shoes without having to use corn pads or a moleskin. Envision no more pain when those toes rub. And how about not feeling embarrassed in yoga class or at the beach about crooked toes? We’ve had patients tell us they avoided open-toed shoes for years, and after surgery, they went and got a pedicure and flaunted those toes happily.

Our patients’ experiences with minimally invasive hammertoe correction have been overwhelmingly positive. One patient said, “I was so surprised I had no scar and I never even saw a pin – my friend had her hammertoes fixed years ago the old way and had a metal pin; I’m so glad I waited and found this technique!”

Dr. Patish takes great care in aligning toes properly – your foot function matters, so we ensure your toes will not only look better but also bear weight properly (no flopping or too short toes).

We also use a touch of humor to keep you at ease – we might call it giving your toes a “makeover” or say we’re sending those hammer shapes to the hardware store where they belong. We know it’s a relief for many to have this done after suffering for a long time, so we keep the atmosphere optimistic.

You don’t have to live with hammertoe pain or hide your feet. Modern medicine has given us ways to fix it with minimal fuss.

If you’re considering hammertoe correction or just want to know your options, call or text to schedule an appointment. Dr. Patish will evaluate your toes and honestly advise if minimally invasive surgery can help (almost always yes if the toes are bothering you and conservative care isn’t enough). We’ll explain the plan, the recovery, and answer all your questions. There’s no pressure – you decide when and if you want to proceed. But at least you’ll have the knowledge.

Take that step toward pain-free, straight toes – you might soon be wiggling them in delight (and in cute shoes). Contact us today and let’s hammer out a solution for those hammertoes – one that will leave you wondering why you didn’t do it sooner!