What Is Flexible Hammertoe Surgery?
A flexible hammertoe is a toe deformity where the middle joint (proximal interphalangeal or PIP joint) bends downward but can still be manually straightened. Unlike rigid hammertoes — where the joint is fixed — flexible hammertoes have preserved passive range of motion. Surgery for flexible hammertoes is highly effective and involves a procedure called proximal interphalangeal joint arthroplasty.
At Balance Foot & Ankle, our surgical team performs hammertoe corrections as outpatient procedures with high patient satisfaction rates. Most patients are walking the same day of surgery and return to regular footwear within four to six weeks.
Who Needs Flexible Hammertoe Surgery?
Conservative treatment — wider shoes, padding, splinting, and metatarsal supports — is always attempted first. Surgery becomes appropriate when the deformity causes persistent pain, creates skin breakdown or ulceration from shoe pressure, interferes with wearing footwear, causes adjacent toe problems, or significantly affects quality of life despite conservative measures.
The best surgical candidates are non-smokers with good peripheral circulation and realistic expectations about recovery. We evaluate circulation using ankle-brachial index measurements and clinical examination before scheduling surgery.
Surgical Technique: PIP Joint Arthroplasty
Proximal interphalangeal joint arthroplasty is the most common procedure for flexible hammertoe correction. The surgery is performed under local anesthesia with sedation in an outpatient surgical facility.
Step-by-Step Surgical Process
A small longitudinal or elliptical incision is made over the top of the PIP joint. The extensor tendon is identified and either released or lengthened to reduce the deforming force pulling the toe upward. The joint is then exposed by releasing the collateral ligaments on each side. A small amount of bone is removed from the head of the proximal phalanx — this creates a space that allows the toe to be repositioned in a straight alignment.
The toe is held in the corrected position temporarily with a smooth Kirschner wire (K-wire) or an internal implant. K-wires protrude from the tip of the toe and are removed in the office at four to six weeks without anesthesia. Newer absorbable or permanent internal implants are available as alternatives for patients who prefer not to have protruding wires.
The incision is closed with absorbable sutures, and the toe is dressed in a corrective position with gauze and medical tape. A surgical shoe that protects the forefoot while allowing heel weight bearing is provided before the patient leaves the facility.
Additional Procedures Performed at the Same Time
Hammertoe correction is often combined with additional procedures addressing the underlying cause of the deformity. A flexor tendon tenotomy releases the flexor tendon on the bottom of the toe, preventing recurrence from the flexor overpowering the extensor. A metatarsal osteotomy may be performed if the long metatarsal is contributing to forefoot overload and hammertoe formation. Bunion correction (bunionectomy) is frequently performed at the same session when a medially deviated first ray is displacing the second toe.
Recovery After Flexible Hammertoe Surgery
First Two Weeks
Patients are weight bearing immediately in the surgical shoe, though elevation and ice are recommended for the first 72 hours to minimize swelling. Driving is restricted on the operative foot until the surgical shoe is discontinued. Dressing changes are performed by the patient every two to three days using materials provided at discharge.
Weeks Two to Six
Swelling gradually decreases but the toe will remain noticeably swollen for two to four months. If a K-wire is present, it is removed at the four to six week visit. Transition to a wide athletic shoe or surgical sandal typically begins at three to four weeks. Light activity such as walking for exercise can resume once the incision is fully healed.
Three to Six Months
Most patients return to all regular footwear by two to three months. Final surgical results — including full swelling resolution and scar maturation — are assessed at the six-month follow-up. Return to athletic activity including running and court sports typically occurs at three months.
Outcomes and Expectations
Patient satisfaction after flexible hammertoe surgery is high, with most studies reporting good to excellent outcomes in over 85 percent of cases. The toe is permanently straightened and footwear fitting improves significantly. Some residual stiffness at the PIP joint is expected and normal — the joint is intentionally made less mobile as part of the procedure.
Recurrence can occur, particularly if the underlying cause (such as an uncorrected bunion or long metatarsal) is not addressed simultaneously. Our surgeons perform comprehensive preoperative planning to identify all contributing factors and correct them in a single operative session when possible.
Risks and Complications
As with all surgery, risks include infection, wound healing complications, deep vein thrombosis, nerve injury, and anesthetic reactions. Hammertoe-specific risks include recurrence of deformity, transfer lesion (pain shifting to an adjacent metatarsal), floating toe (a toe that does not contact the ground), and vascular compromise. These complications are uncommon when surgery is performed by an experienced foot and ankle surgeon with appropriate patient selection.
Ready to Relieve Your Foot Pain?
Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.
Book Your AppointmentPainful Hammertoe Deformity?
Our foot surgeons perform minimally invasive PIP joint arthroplasty to straighten hammertoes with excellent outcomes.
Book an AppointmentMore Podiatrist-Recommended Hammertoe Essentials
Extra-Depth Orthopedic Shoe
Orthofeet Sprint — tall toe box prevents hammertoe rubbing and friction.
Wide-Toe-Box Walking Shoe
New Balance 990v6 — accommodates curled toes without pressure.
Supportive Insole
PowerStep Pinnacle — reduces forefoot pressure that drives hammertoe.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Rigid hammertoes don’t reduce with splinting alone — the tendon and capsule have contracted. If the toe no longer straightens passively, surgical correction restores alignment in one short outpatient visit. Call Balance Foot & Ankle to see whether your deformity is still flexible (and responsive to the conservative tools above) or if it’s time for a 20-minute in-office correction.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
How long does recovery take after flexible hammertoe surgery?
Patients wear a post-op surgical shoe for 4-6 weeks with protected weight-bearing. Return to regular shoes occurs around 6-8 weeks, with full recovery by 3 months.
Is hammertoe surgery painful?
Most patients experience mild to moderate pain controlled with oral medication for 3-5 days. Ankle or regional blocks during surgery provide 12-24 hours of initial pain relief.
What is the difference between flexible and rigid hammertoe surgery?
Flexible hammertoes are corrected with tendon releases and PIP arthroplasty. Rigid deformities require more extensive bone work, PIP fusion, and longer recovery periods.
Insurance Accepted
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
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Same-week appointments available at both locations.
Book Your AppointmentIn Our Clinic
Hammertoes come to our clinic in two flavors: flexible (the toe still passively straightens) and rigid (it doesn’t). For flexible hammertoes we use gel toe crests, roomier toe boxes, custom orthotics to address the underlying instability, and sometimes night splints. Rigid hammertoes with a corn on top of the PIP joint, or a callus under the metatarsal head, usually need a minor outpatient procedure (PIP arthroplasty or fusion) to straighten the toe. The patients who wait too long develop fixed deformities and skin breakdown — we would much rather address a flexible hammertoe early.
In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Hammertoe Treatment Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
★ DR. TOM’S COMPLETE 2026 ORTHOTIC RANKING
9 Best Prefab Orthotics by Use Case
PowerStep, Currex, Spenco, Vionic, and PowerStep Pinnacle — every orthotic I’ve fitted to thousands of patients across both Michigan offices. Each card includes pros, cons, and the specific patient I’d give it to. Real Amazon ratings, review counts, and prices below.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)