Bunion: a bony bump that forms on the joint at the base of your big toe. A bunion forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore.
Wearing tight, narrow shoes might cause bunions or might make them worse. Bunions can also develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.
The signs and symptoms of a bunion include:
- A bulging bump on the outside of the base of your big toe
- Swelling, redness or soreness around your big toe joint
- Thickening of the skin at the base of your big toe
- Corns or calluses — these often develop where the first and second toes overlap
- Persistent or intermittent pain
- Restricted movement of your big toe
When to see a doctor
Although bunions often require no medical treatment, see your doctor or a doctor who specializes in treating foot disorders (podiatrist or orthopedic foot specialist) if you have:
- Persistent big toe or foot pain
- A visible bump on your big toe joint
- Decreased movement of your big toe or foot
- Difficulty finding shoes that fit properly because of a bunion
Smaller bunions (bunionettes) also can develop on the joint of your little toes.
Bunions develop when the pressures of bearing and shifting your weight fall unevenly on the joints and tendons in your feet. This imbalance in pressure makes your big toe joint unstable, eventually molding the parts of the joint into a hard knob that juts out beyond the normal shape of your foot.
Experts disagree on whether tight, high-heeled or too-narrow shoes cause bunions or whether footwear simply contributes to bunion development. Other causes include:
- Inherited foot type
- Foot injuries
- Deformities present at birth (congenital)
Bunions may be associated with certain types of arthritis, particularly inflammatory types, such as rheumatoid arthritis. An occupation that puts extra stress on your feet or one that requires you to wear pointed shoes also can be a cause.
What is a hammertoe?
A hammertoe is a deformity that causes a toe to become bent upward in the middle so it resembles a hammer. Hammertoes often occur in conjunction with other toe problems. It is possible to develop corns on top of the middle joint of the hammertoe.
Patients who have hammertoes try to manage them by treating the symptoms. This involves padding the toe and changing or stretching shoewear for comfort. If you still experience discomfort from the hammertoe you may consider surgery.
The hammertoe can be flexible or stiff. Depending on the flexibility of the toe and the preference of your orthopaedic foot and ankle surgeon, several different surgeries can be used to treat the hammertoe.
What is the goal of hammertoe surgery?
The goal of surgery is to treat pain that has not gotten better with non-surgical treatment.
What signs indicate hammertoe surgery may be needed?
If you have pain or cannot comfortably wear shoes after trying non-operative treatments, hammertoe surgery may be an option.
When should I avoid hammertoe surgery?
Patients with multiple problems in addition to the hammertoe should avoid surgery for just the hammertoe alone. Additional surgery may be needed to address the other deformities as well. Other reasons to avoid hammertoe surgery include active infections, poor circulation, and any serious illness that would make surgery unsafe. You should discuss your health history with your orthopaedic surgeon prior to considering hammertoe surgery.
General Details of the Procedure
Most often, hammertoe correction is done as an outpatient procedure. This means that you can go home the same day as the surgery. The surgery can either be done with you fully asleep, or it may be done with you awake after you have been given medicine that makes the foot go numb temporarily.
Flexible Hammertoe: If your hammertoe is flexible and your orthopaedic surgeon can straighten the toe, a tendon transfer procedure may be used to correct the problem. This involves rerouting the tendons from the bottom of the toe to the top of the toe where it is sticking up. This helps pull the bent joint into a straight position.
Fixed Hammertoe: If your hammertoe has become fixed (stiff), there are two options for treatment. Joint resection can be used to treat the fixed hammertoe. In this procedure an incision is made over the top of the toe. Ligaments and tendons may be cut to help with straightening the toe. The end of the bone is removed to allow the toe to straighten completely, and pins are temporarily used to hold the toe straight. The pins are usually removed three to four weeks after the surgery.
Fusion can also be used to treat the fixed hammertoe. In this procedure, the ligaments and tendons are cut to help straighten the toe. The ends of the bone are cut and the toe is straightened. Pins, screws or other implants can be used to keep the toe straight while the bone ends heal together.
What happens after surgery?
You may be given a special shoe to wear after surgery to help with walking. Recovery normally can take a few weeks depending on the type of surgery that was done.
You will be asked to keep your foot elevated at the level of your heart for the first few weeks after surgery, which requires lying on a couch or bed with your foot up. You may also need either crutches or a walker after surgery depending on your ability to walk.
Stitches are usually taken out two to three weeks after surgery, and if pins were placed, these will be taken out within a few weeks. You may not put your foot under water until the stitches and pins are removed.
If the hammertoe is on your right foot, you may not be able to drive a car for a number of weeks depending on the type of surgery you have.
Your orthopaedic surgeon may ask you to do exercises to stretch and move the toe at home after surgery. This can help with flexibility of the toe and to maintain motion in the toe.
It is normal to have swelling after surgery. It may take up to one year before the swelling resolves.
There are possible complications after surgery for hammertoe correction that relate to surgery in general. Infection, damage to nerves and vessels, bleeding, blood clots and risks related to anesthesia are all possible.
Complications specific to hammertoe surgery include a small chance that the hammertoe may come back after your surgery. There is a risk that after the surgery you may feel like the toe is unstable. This is due to the cutting of ligaments and tendons. The risk is small because pins are used to hold the toe in place for a few weeks while the toe heals. If you have a fusion there is a small risk of the bones not healing. These complications are all rare. Discuss the potential complications with your orthopaedic surgeon prior to undergoing hammertoe correction.
Frequently Asked Questions
If I am treated with surgery will the hammertoe ever come back?
It is possible that after surgery your hammertoe may come back. If this happens and you have discomfort in the toe, an additional surgery may be needed to address the pain.
Can I bend my toe after surgery?
Depending on the specific surgery used, you may or may not be able to bend your toe once it has healed. Ask your orthopaedic surgeon what type of surgery is needed for your hammertoe.