Hammertoe deformities — flexion contractures of the lesser toe interphalangeal joints — are among the most common forefoot conditions requiring surgical correction. Three surgical procedures are in common use — flexor tenotomy, proximal interphalangeal (PIP) joint arthroplasty, and PIP joint arthrodesis — and their selection depends on the flexibility of the deformity, the severity of contracture, patient activity level, and the status of the MTP joint.

The Flexibility Assessment

The most critical pre-operative assessment is distinguishing flexible from rigid hammertoe deformity. A flexible hammertoe passively corrects to neutral — the PIP joint can be manually straightened without resistance. A rigid hammertoe cannot be passively corrected. This distinction determines surgical options: flexible hammertoes can be corrected with soft tissue procedures (flexor tenotomy, flexor-to-extensor tendon transfer); rigid hammertoes require bony procedures. The MTP joint must also be assessed — concurrent MTP joint dislocation or severe hyperextension significantly affects the surgical plan because an uncorrected MTP deformity will cause recurrence of PIP flexion regardless of the toe procedure performed.

Flexor Tenotomy

Percutaneous flexor tenotomy — dividing the flexor digitorum longus tendon through a small plantar stab incision at the toe base — is the procedure of choice for flexible hammertoes, particularly in diabetic patients with plantar toe ulceration from the flexion deformity. The procedure is performed under local anesthesia in the office, requires no formal recovery, and carries minimal wound complication risk — making it the preferred option for high-surgical-risk patients. Limitations are that it is effective only for flexible deformities and does not address rigid contractures.

PIP Arthroplasty vs. Arthrodesis

For rigid hammertoes, both PIP arthroplasty (resecting the condyles of the proximal phalanx head to create a fibrous union) and PIP arthrodesis (fusing the joint in corrected position with a k-wire or internal fixation implant) effectively correct the deformity. Arthroplasty has faster recovery and preserves some residual joint mobility — but produces a “floppy” toe in some patients and has higher recurrence rates than arthrodesis. Arthrodesis produces more reliable long-term correction and higher patient satisfaction in most studies, at the cost of permanent loss of PIP joint motion (which most patients do not notice functionally). Modern small-implant internal fixation devices (Nextradesis, Smart Toe) have replaced temporary k-wire fixation in many practices — eliminating the k-wire protruding from the toe tip and allowing immediate weight-bearing in surgical footwear. Dr. Biernacki at Balance Foot & Ankle performs comprehensive hammertoe evaluation and surgical correction. Call (810) 206-1402 for consultation at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

What causes hammertoes?

Hammertoes are primarily caused by muscle-tendon imbalances in the foot, often from wearing shoes that are too narrow or too short. Flat feet, high arches, arthritis, and certain neurological conditions can also contribute. Genetics play a role in predisposition.

Can hammertoes be fixed without surgery?

Flexible hammertoes (early stage) can be managed with padding, toe splints, wider shoes, and custom orthotics that address the underlying imbalance. Rigid hammertoes (contracted joints) typically require surgery for correction.

How long is hammertoe surgery recovery?

Most hammertoe surgeries allow walking in a surgical shoe immediately. Swelling continues to resolve for 2–3 months. Most patients are back in regular shoes within 6–8 weeks and fully recovered within 3–4 months.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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Dr. Tom Biernacki, DPM

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.