What is MIS Hammertoe Surgery?
A hammertoe, is a deformity of any of the lesser toes (second through fifth toes), where the toe gets bent upward at the toe’s middle joint. It occurs as a result of imbalance in the ligaments and tendons that support the toe’s position. Hammertoes can be caused by ill-fitting footwear, trauma, genetics, foot structure, and as a complication of arthritis and certain neuromuscular conditions.
Standard open surgery to correct hammertoes generally involves making large incisions to cut, lengthen or transfer tendons and/or excise or fuse the joints of the toes. Fixation devices such as screws, pins, and wires are often required to hold the toes straight and the toes tend to be very stiff post-surgery.
On the contrary, MIS or minimally invasive surgery for hammertoe is a surgical procedure carried out through tiny incisions using very fine instruments, rather than a large, open incision as in traditional surgery. Implants such as screws, pins, and staples are often used, but are not required and sometimes the alignment can be maintained using tape and wrapping.
Benefits of MIS hammertoe surgery over traditional hammertoe surgery include:
- Small incisions
- Shorter recovery period
- Reduced postoperative pain
- Minimal blood loss
- Minimal muscle trauma
- Less scaring
- Earlier mobilization
- Faster healing time
Indications for MIS Hammertoe Surgery
Your surgeon may recommend MIS hammertoe surgery if:
- You have significant hammertoe pain and/or callosities that limits your activities of daily living (ADL)
- Your pain is persistent and getting worse despite trying conservative measures.
- It is difficult to find comfortable shoes that fit because of your hammer toes.
- Nonsurgical treatment modalities such as orthotics, taping, callus/corn pads have failed.
Preparation for MIS Hammertoe Surgery
Preoperative preparation for MIS hammertoe surgery may involve the following steps:
Procedure for MIS Hammertoe Surgery
Minimally invasive surgery for hammertoe is typically performed as a same-day surgery under general anesthesia, hence you will remain conscious throughout the procedure. In general, the procedure will typically involve the following steps:
- The skin over the hammertoe is cleaned with an antiseptic solution.
- Small incisions are made over the treatment area with the aid of specialized instruments.
- Minimally invasive correction involves surgery to the soft tissues and/or bones and joints.
- Surgery to the soft tissues may involve releasing/lengthening tendons and releasing tight joints.
- Surgery to the bones involves osteotomies (making tiny incisions) to re-align them utilizing specialized burrs (tiny drills). In some cases, it is essential to operate on the small joints of the toes (distal and proximal interphalangeal joints) which can be fused to correct the deformity in some situations.
- The desired toe alignment is maintained using implants such as screws, pins, or staples.
- The incisions are closed with stitches or surgical tape and a sterile dressing with or without a splint/post -op shoe/CAM boot is applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery will involve the following:
Risks and Complications
MIS hammertoe surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Recurrence of deformity
- Continued pain and discomfort of the involved toes
- Infection
- Bleeding
- Nerve injury