Hammertoe Surgery Types: Arthroplasty vs Arthrodesis

Hammertoe surgery corrects pathological flexion contracture of the proximal interphalangeal (PIP) joint — and in some cases the distal interphalangeal (DIP) joint — of the lesser toes, relieving dorsal corn pain, metatarsalgia, and shoe fit difficulty that have not responded to conservative management. The choice of surgical procedure depends on whether the contracture is flexible (passively correctable) or rigid (fixed), which joint is primarily involved, and whether the metatarsophalangeal (MTP) joint is subluxed or dislocated in addition to the digital deformity. The three primary surgical approaches are: arthroplasty (resection of the joint), arthrodesis (fusion of the joint), and flexor tendon transfer (rerouting the flexor tendon to act as an extensor). Each has distinct indications, fixation requirements, and recovery timelines, and each can be combined with adjunctive procedures such as MTP joint release, extensor tendon lengthening, metatarsal shortening osteotomy, or plantar plate repair to achieve comprehensive correction of complex combined deformities.

Hammertoe Surgery: Arthroplasty vs. Arthrodesis vs. Flexor Tendon Transfer

Procedure	Technique	Best For	Fixation	Outcome	Key Risk
PIP arthroplasty (condylectomy)	Resect head of proximal phalanx at PIP joint; remove joint cartilage and bone; allows fibrous healing in corrected position; NO fusion	Flexible or mild rigid hammertoe; elderly patients (avoid prolonged recovery of fusion); patients wanting to preserve some PIP mobility	K-wire through toe tip for 4-6 weeks; or suture repair only	Good: 70-85% satisfaction; floating toe possible; less durable than fusion in active patients; recurrence 15-25% at 5 years	Floating toe (toe lifts off ground, loses plantar pressure); floppy/unstable toe if fibrous union doesn’t provide adequate stability
PIP arthrodesis (fusion)	Resect cartilage from both sides of PIP joint; create flat-on-flat bone surfaces; fuse in slight flexion (5-10°); rigid internal fixation	Rigid hammertoe; recurrent hammertoe; active patients; when durability prioritized over motion; younger patients; severe deformity	K-wire (most common); intramedullary implant (Smart Toe, StayFuse); headless compression screw — each has distinct nonunion and hardware complication profiles	Best: 80-90% satisfaction; more durable than arthroplasty; toe remains stable and plantargrade; nonunion 5-15% (fibrous nonunion may still be functional)	Nonunion; implant complications (breakage, infection); fixed rigid toe (cannot flex for tight shoes); toe shortening from resection
Flexor tendon transfer (Girdlestone-Taylor)	Release flexor digitorum longus from distal attachment; split tendon; transfer both slips dorsally around proximal phalanx to extensor hood; creates dynamic extensor force	Flexible hammertoe with MTP joint instability; mallet toe deformity; floating toe; when maintaining PIP motion desired; younger patients with dynamic deformity	No hardware required for tendon transfer itself; K-wire through MTP joint for 4-6 weeks if MTP instability present	Good for flexible deformity: 70-80% satisfaction; less effective for rigid PIP contracture (often combined with arthroplasty); toe tends to remain straighter with preserved muscle balance	Overcorrection (cock-up toe deformity); recurrence if MTP instability not simultaneously addressed; requires intact neurovascular status for tendon viability

Hammertoe Surgery: Deformity Classification and Adjunctive Procedures

Deformity Type	Joints Involved	Primary Procedure	Common Adjuncts	Recovery
Flexible hammertoe	PIP flexion (passively correctable); MTP may be neutral	Flexor tendon transfer (Girdlestone-Taylor) OR conservative management — flex deformity corrects passively, surgery may be premature	Extensor tendon lengthening if MTP extension contracture present	Protected WB in surgical shoe 4-6 weeks; full shoe 6-8 weeks
Rigid hammertoe	Fixed PIP flexion contracture (not passively correctable); MTP may be hyperextended	PIP arthrodesis (preferred) or arthroplasty; MTP joint release if contracted	MTP joint capsule release; extensor digitorum longus lengthening; metatarsal shortening (Weil osteotomy) if metatarsal too long	Non-WB 2 weeks; surgical shoe 4-6 weeks; full shoe 8-10 weeks; K-wire removal at 4-6 weeks
Mallet toe	DIP flexion contracture; PIP neutral or mildly involved	DIP arthroplasty (FDL tenotomy + condylectomy); or DIP arthrodesis if rigid	Nail bed management if distal toe pressure producing nail changes	Surgical shoe 3-4 weeks; faster than PIP procedures
Claw toe	MTP hyperextension + PIP flexion + DIP flexion (all three joints)	MTP release + PIP arthroplasty or arthrodesis + FDL tenotomy or transfer	Weil metatarsal shortening osteotomy; plantar plate repair; extensor tendon lengthening — this is the most complex lesser toe deformity requiring comprehensive correction	Non-WB 2-3 weeks; surgical shoe 6-8 weeks; return to regular shoe 10-12 weeks
Crossover toe (MTP instability)	MTP instability with medial or lateral deviation of toe; associated plantar plate tear	Plantar plate repair + MTP soft tissue correction; flexor tendon transfer for dynamic support; K-wire for positioning	Dermal rotation flap occasionally needed; metatarsal shortening common; adjacent digit procedures often simultaneous	Non-WB 3-4 weeks; K-wire at 6 weeks; full activity 3-4 months

At Balance Foot & Ankle in Howell and Bloomfield Hills, hammertoe surgery planning involves weight-bearing X-rays and careful assessment of whether the deformity is flexible or rigid, which joints are involved, and whether MTP instability or metatarsal length discrepancy requires simultaneous correction — because operating on the PIP joint alone without addressing contributing MTP and metatarsal pathology leads to recurrence. Call (810) 206-1402.