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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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your hammertoe, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

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.

Book Online or call (810) 206-1402

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.

Explore Hammertoe Treatment | Book Your Appointment | Call (810) 206-1402

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.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Hammertoe and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Mallet toe. Bend at the distal joint only (DIP), not the middle joint.
• Claw toe. Both joints (PIP + DIP) bent — usually multiple toes, often diabetic.
• Crossover toe (2nd MTP). Drift across the big toe — often plantar plate tear underneath.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Cutting corns at home with scissors or razors. Fix: professional podiatric enucleation with sterile instruments prevents infection and recurrence.

Warning Signs That Need Same-Day Care