Hammertoe Surgery: Arthroplasty vs. Arthrodesis — Which Procedure Is Right for You?

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

When conservative hammertoe management fails to provide adequate relief, surgery can straighten the deformed toe and resolve pain from shoe pressure and nail problems. The two main surgical options — proximal interphalangeal joint (PIPJ) arthroplasty and PIPJ arthrodesis — have distinct advantages and trade-offs that depend on the patient’s toe flexibility, activity level, and goals.

Anatomy of Hammertoe Deformity

A hammertoe deformity involves flexion contracture at the proximal interphalangeal joint (PIPJ) — the middle knuckle of the lesser toes — causing the toe to curve downward. The extensor and intrinsic muscle balance is disrupted, with the long extensor (EDL) overpowering the intrinsics, dorsiflexing the metatarsophalangeal joint (MTPJ) and flexing the PIPJ. The result is a “Z-shaped” deformity that creates dorsal pressure at the PIPJ from shoe pressure and tip pressure at the toe tip.

Hammertoe is distinguished from claw toe (flexion at both PIPJ and DIPJ with MTP hyperextension) and mallet toe (flexion at the DIPJ only). Classification as flexible (corrects passively) vs. rigid (fixed deformity) is the key surgical planning criterion.

Conservative Treatment Before Surgery

Surgery is considered only after conservative measures fail: toe pads or shields to protect the dorsal PIPJ prominence, wider or deeper toe-box footwear, accommodative orthotics, and digital splinting for flexible deformities. Corticosteroid injection for associated MTPJ synovitis addresses a common contributing factor. Flexible hammertoes respond much better to conservative treatment than rigid ones.

PIPJ Arthroplasty (Condylectomy)

Arthroplasty removes the head of the proximal phalanx (the bony prominence causing the dorsal corn), creating a pseudoarthrosis — a fibrous joint rather than a fused one. The procedure straightens the toe, eliminates the PIPJ prominence, and preserves some toe flexibility. Kirschner wire (K-wire) fixation is typically used for 3–4 weeks postoperatively to maintain alignment while soft tissue healing occurs.

Advantages: preserves some toe motion, slightly faster recovery, lower nonunion concern. Disadvantages: higher recurrence rate (10–20%) for rigid deformities, less predictable long-term alignment, risk of “floppy toe” syndrome from excessive bone removal. Best suited for flexible hammertoes in patients who prioritize some toe motion.

PIPJ Arthrodesis (Fusion)

Arthrodesis removes cartilage from both sides of the PIPJ and fixates the joint in a straight position until bone heals across it. Modern fixation options include intramedullary implants (Smart Toe, StayFuse, HammerFix), absorbable pins, and traditional K-wires. Bone union produces a permanently straight, stable toe with a predictable outcome.

Advantages: lower recurrence rate, more predictable alignment, durable correction of rigid deformities. Disadvantages: permanent loss of PIPJ motion (though the DIP joint retains motion), slightly longer healing time (6–8 weeks for bone union), nonunion risk (approximately 5–10% with intramedullary implants, higher with K-wire).

PIPJ arthrodesis is preferred for rigid hammertoes and in patients with prior arthroplasty failure. Intramedullary implant fixation has largely replaced K-wire for primary arthrodesis due to convenience (no external wire), lower infection risk, and equivalent union rates.

Concomitant Procedures

Hammertoe correction rarely occurs in isolation. Metatarsophalangeal joint release (extensor tendon lengthening, MTPJ capsulotomy, collateral ligament release) addresses the dorsal contracture component. Weil metatarsal osteotomy shortens an overly long metatarsal and reduces MTPJ plantar pressure. Plantar plate repair addresses second toe crossover deformity with plantar plate attenuation. Combined procedures targeting all anatomic contributors produce superior outcomes to isolated hammertoe correction.

At Balance Foot & Ankle, Dr. Biernacki evaluates hammertoe deformity and performs arthroplasty, arthrodesis, and combined reconstructive procedures at both Bloomfield Hills and Howell offices. Call (810) 206-1402 to schedule a lesser toe evaluation.

Hammertoe Surgery Options in Howell & Bloomfield Hills

When conservative treatments can’t straighten a painful hammertoe, surgical correction restores toe alignment and eliminates pain. Our podiatric surgeons perform both arthroplasty and arthrodesis procedures tailored to your specific deformity and lifestyle.

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

Clinical References

1. Coughlin MJ, et al. Operative repair of the fixed hammertoe deformity. Foot & Ankle International. 2000;21(2):94-104.
2. Kramer WC, et al. Hammertoe correction with K-wire fixation. Foot & Ankle International. 2015;36(5):494-502.
3. Schrier JC, et al. PIP joint arthrodesis versus arthroplasty for hammertoe: a systematic review. Foot and Ankle Surgery. 2016;22(3):141-147.

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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.