Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

When Hammertoes Need Surgery

Hammertoe deformities — where the toe bends abnormally at one or both of the smaller toe joints, creating a curved, claw-like position — affect millions of Americans. Most hammertoes begin as flexible deformities that can be straightened manually. Over years, the deformity progressively stiffens as the joint capsule and tendons contracture, eventually becoming rigid and fixed regardless of manual pressure.

Conservative management with padding, toe splints, wider footwear, and orthotics successfully controls symptoms in many patients. When deformities become rigid, cause persistent pain despite conservative care, create non-healing corns or calluses, significantly limit footwear options, or restrict daily activity, surgical correction is appropriate and provides excellent long-term results.

At Balance Foot & Ankle, our foot surgeons perform hammertoe corrections with meticulous technique tailored to each patient’s specific deformity pattern. We take a comprehensive approach that addresses all contributing factors — not just the most prominent toe — to achieve durable, functional results.

Understanding Hammertoe Anatomy

Three types of toe deformity are distinguished by which joint is primarily affected. A true hammertoe involves flexion contracture at the proximal interphalangeal (PIP) joint — the middle joint of the toe — with the metatarsophalangeal (MTP) joint in neutral or extension. A claw toe involves flexion at the PIP joint and the distal interphalangeal (DIP) joint with extension (dorsiflexion) at the MTP joint. A mallet toe involves isolated flexion contracture of the DIP joint — the joint closest to the toenail.

The underlying mechanism in all three involves muscle and tendon imbalance. The intrinsic foot muscles that normally stabilize the MTP joint weaken, while the long flexor and extensor tendons pull the toe into the deformed position. This imbalance progressively stiffens the contracture as the joint capsule and surrounding soft tissues adapt to the abnormal position.

Evaluation Before Surgery

Thorough preoperative evaluation includes assessment of deformity flexibility, presence of dislocation at the MTP joint, skin integrity over affected joints, neurovascular status, adjacent toe involvement, and any bunion deformity at the first metatarsal that may be driving adjacent toe crowding. Weight-bearing X-rays provide the roadmap for surgical planning, showing joint alignment, bone length, and any arthritic changes.

Important patient factors including circulation status, diabetes, smoking history, and medication use (particularly blood thinners) are assessed. Circulatory compromise and active infection are contraindications to elective hammertoe surgery.

Surgical Options for Flexible Hammertoes

Flexor Tendon Transfer (Girdlestone-Taylor Procedure)

For flexible hammertoes — those that straighten fully with manual correction — the Girdlestone-Taylor flexor tendon transfer rebalances the forces acting on the toe without resecting joint surfaces. The flexor digitorum longus tendon is split longitudinally and the two slips are brought to the dorsum of the toe and attached to the extensor apparatus. This converts the flexor from a deforming force into a dynamic stabilizer of the MTP joint.

This technique preserves joint integrity, maintains normal joint anatomy, and provides a dynamic correction that is well-suited for athletic patients and younger individuals. Recovery allows weight bearing in a protective shoe immediately, with return to normal footwear in 4 to 6 weeks.

Surgical Options for Rigid Hammertoes

Proximal Interphalangeal Joint Arthroplasty (DuVries Procedure)

PIP joint arthroplasty removes a small segment of bone from the condyles of the proximal phalanx, creating space that allows the joint to straighten. The toe is held in the corrected position during healing with an intramedullary pin (K-wire) that passes through the tip of the toe. The pin is removed in the office at 3 to 4 weeks without anesthesia.

This is the most commonly performed hammertoe procedure and provides reliable correction with quick recovery. The MTP joint capsule may require concurrent release when the MTP joint is subluxated or dislocated. Minor shortening of the toe is an expected consequence of bone removal.

Proximal Interphalangeal Joint Fusion (PIP Arthrodesis)

PIP fusion provides more durable correction than arthroplasty by permanently fusing the PIP joint in straight position. The joint surfaces are prepared, the bone ends are opposed, and fixation is achieved with an absorbable pin, metal pin, or small implant that remains permanently. The fused joint is straight and rigid, eliminating the possibility of deformity recurrence at the fused joint.

PIP fusion is preferred for severe or recurrent deformities, for patients at high risk of recurrence, and for the lesser toe of patients requesting the most durable correction. The sacrifice of PIP joint motion is well tolerated — the toe functions adequately for all normal activities with the PIP joint fused in a straight position.

A variety of fusion implants have been developed including absorbable devices that do not require removal, titanium cannulated implants (Smart Toe, Nextra), and traditional K-wire fixation. The choice among these depends on bone quality, patient factors, and surgeon preference.

Weil Osteotomy for MTP Dislocation

When the MTP joint is subluxated or dislocated — a common finding with chronic hammertoe deformity — correcting only the PIP joint does not address the root cause at the MTP level. A Weil osteotomy shortens and realigns the metatarsal by making an oblique cut through the metatarsal neck, sliding the head proximally, and securing it with a small screw. This reduces MTP joint pressure, allows joint reduction, and is frequently combined with PIP procedures for comprehensive hammertoe correction.

Addressing the Cause: Concurrent Bunion Correction

A significant proportion of lesser toe hammertoe deformities develop secondary to hallux valgus (bunion). As the great toe drifts toward the second toe, it compresses and destabilizes the adjacent digits. Correcting hammertoes without simultaneously correcting the underlying bunion allows the bunion to push the corrected toes back into deformity. We assess every hammertoe patient for concurrent first ray pathology and plan comprehensive correction when indicated.

Recovery After Hammertoe Surgery

Hammertoe correction is performed as an outpatient procedure under regional or sedation anesthesia. Weight bearing in a flat surgical shoe is permitted immediately after surgery for most procedures. Swelling resolves over 6 to 12 weeks, with significant residual swelling often persisting for the full 12 weeks even when shoes fit comfortably earlier. Return to supportive athletic footwear typically occurs at 6 to 8 weeks.

Common expected findings during recovery include swelling, mild bruising, and the toe feeling stiff and slightly numb from local anesthetic resolution. A temporary pin at the toe tip (K-wire fixation) is removed at the 3 to 4 week visit with minimal discomfort.

Outcomes and Patient Satisfaction

Hammertoe surgery carries high patient satisfaction rates. The vast majority of patients report improved comfort in footwear and resolution of the painful corns and calluses that drove their decision to pursue surgery. Recurrence of deformity is possible, particularly if the underlying biomechanical causes are not comprehensively addressed.

To schedule a consultation for hammertoe evaluation and discuss whether surgical correction is appropriate for your situation, contact Balance Foot & Ankle. We serve patients throughout Southeast Michigan with convenient clinic locations in Wayne, Oakland, and Macomb counties.

Ready to Relieve Your Foot Pain?

Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.

Book Your Appointment

Hammertoe Surgery & Correction at Balance Foot & Ankle

When conservative measures fail to relieve hammertoe pain, surgical correction can restore toe alignment and function. Dr. Tom Biernacki at Balance Foot & Ankle performs minimally invasive hammertoe correction at our Howell and Bloomfield Hills offices.

Learn About Our Hammertoe Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Coughlin MJ, et al. “Hammertoe deformity: proximal interphalangeal joint arthrodesis.” Foot and Ankle Clinics. 2011;16(4):547-560.
2. Kramer WC, et al. “Surgical treatment of hammertoe deformity: outcomes and complications.” Journal of Foot and Ankle Surgery. 2015;54(6):1130-1134.
3. Schrier JC, et al. “Minimally invasive hammertoe correction: a systematic review of clinical outcomes.” Foot and Ankle Surgery. 2021;27(1):11-19.