Hammertoe Surgery: Flexor Tenotomy, PIP Fusion, and MTP Arthroplasty — Choosing the Right Procedure

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

Hammertoe — a flexion deformity at the proximal interphalangeal (PIP) joint, often combined with hyperextension at the metatarsophalangeal (MTP) joint — is the most common lesser toe deformity requiring surgical correction. The choice between the three primary surgical approaches — percutaneous flexor tenotomy, PIP joint fusion (arthrodesis), and MTP joint release/arthroplasty — depends on the flexibility of the deformity, the primary joint involved, and the severity of concurrent MTP joint subluxation.

Flexible vs. Rigid Hammertoe

The critical distinction guiding surgical planning: flexible hammertoe (the PIP joint reduces passively with manual pressure) vs. rigid hammertoe (the PIP joint is fixed in flexion and does not reduce). Flexible hammertoes are amenable to soft tissue procedures that release the deforming force without osseous correction. Rigid hammertoes require osseous correction (bony resection or fusion) to achieve a straight, stable toe. The Kelikian push-up test (pushing up on the metatarsal head from the plantar surface) identifies whether MTP joint subluxation reduces — if it does, the MTP component is flexible and soft tissue release alone is sufficient.

Surgical Options

Flexor tenotomy: percutaneous transection of the flexor digitorum longus tendon at the PIP joint level — appropriate for flexible hammertoe without MTP subluxation; performed under local anesthesia in the office setting with immediate weight-bearing. PIP arthrodesis: removal of the articular surfaces of the proximal and middle phalanges and fusion with a K-wire or intramedullary implant (Weil-type, Smart-Toe) — the gold standard for rigid hammertoe correction; produces a permanently straight toe. Weil osteotomy of the metatarsal head: shortening osteotomy that reduces MTP joint subluxation when the metatarsal is excessively long or elevated — typically combined with PIP arthroplasty or arthrodesis for MTP-driven hammertoe. Dr. Biernacki at Balance Foot & Ankle evaluates hammertoe deformity with standing X-rays and flexibility assessment, providing individualized surgical planning for each patient. Call (810) 206-1402 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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Hammertoe Surgery Options in Michigan

From minimally invasive flexor tenotomy to PIP fusion and MTP arthroplasty, our podiatric surgeons offer the full range of hammertoe correction procedures. We match the surgical technique to your specific deformity type and severity.

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Clinical References

1. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000;21(2):94-104.
2. Klammer G, Baumann G, Moor BK, et al. Early complications and recurrence rates after Kirschner wire transfixion in lesser toe surgery. Foot Ankle Int. 2012;33(2):105-112.
3. Schrier JC, Verheyen CC, Louwerens JW. Surgery for hammer toe deformity. Foot Ankle Int. 2009;30(7):580-600.