Hammer toe Correction 28285

CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References


 Hammer Toe Correction CPT

Hammer Toe Correction Indications

  • Symptomatic hammer toe (pain and or preulcerative lesion)

 Hammer Toe Correction Contraindications

  •  Active infection
  • Poor vascularity

Hammer Toe Correction Alternatives

  • Conservative care

Hammer Toe Correction Pre-op Planning

  • Gold standard treatment is PIP joint resection arthroplasty
  • Consider PIP arthrodesis  for severe deformities

Hammer Toe Correction Technique

  • Supine postition
  • Pre-op antibiotics
  • Sign operative site
  • Prep and drap
  • Dorsal longitudinal incision over PIP joint
  • Expose and cut extensor tendon
  • Expose PIP joint and release collateral ligaments.
  • Release plantar plate and expose condyle of proximal phalanx
  • Resect condyle with sagittal saw and 90 degrees to the axis of the proximal phalanx
  • For Resection arthroplasty: pin joint in reduced position with 0.045 K-wire.
  • If MTP joint corrects with Push-up test preceed to closure, if not perform MTP releases
  • For Arthrodesis:  Resect the articular cartilage from the base of the middle phalanx with sagittal saw and follow implant manufactures guide for arthrodesis.  
MTP Release
  • Incision over MTP joint. 
  • Expose and lengthen extensor longus tendon in Z-fashion. 
  • Perform extensor brevis tenotomy.
  • If needed release capsule and dorsal 1/3 of collateral ligaments.
  • Pin MTP joint in 5 degrees of flexion at the MTP joint with 0.062 K-wire

Hammer Toe Correction Complications

Hammer Toe Correction Follow-up care

  • Post-op: dressing, hard soled shoe
  • 7-10 Days: evaluate K-wires, continue pin care. 
  • 3 Weeks:evaluate K-wires, continue pin care. 
  • 6 Weeks: remove K-wires. (Toe malalignment with k-wires removed at 3 weeks (47.8%) compared with removal at 6 weeks (8.7%). (Klammer G, Foot Ankle Int. 2012 Feb;33(2):105-12. doi: 10.3113/FAI.2012.0105. PubMed)
  • 2 Months:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Hammer Toe Correction Outcomes

Hammer Toe Correction Review References

  •  Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle. 2000;21:94-104.
  • Shaw AH, Alvarez G. The use of digital implants for the correction of hammer toe deformity and their potential complications and management. J Foot Surg. 1992;31(1):63-74,
  • Mann RA, Mizel MS. Monarticular non-traumatic synovitis of the MTP joint: A new diagnosis? Foot Ankle. 1985;6:18-21.
  • Thompson FM, Deland JT. Flexor tendon transfer for metatarsophalangeal instability of the second toe. Foot Ankle. 1993;14:385-388.
  • Fortin PT, Myerson MS. Second metatarsophalangeal joint instability. Foot Ankle Int. 1995;16(5):306-313.
  • Gazdag A, Cracchiolo A. Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. Foot Ankle Int. 1998;19:137-143.
  • Barbari SG, Brevig K. Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. Foot Ankle. 1984;5:67-73.
  • Parrish TF. Dynamic correction of clawtoes. Orthop Clin North Am. 1973;4:97-102.
  • Turan I. Deformities of the smaller toes and surgical treatment. J Foot Surg. 1990;29:176-178.
  • Alvine F, Garvin KL. Peg and dowel fusion of the proximal interphalangeal joint. Foot Ankle. 1980;1:90-94.
  • Coughlin MJ. Crossover second toe deformity. Foot and Ankle. 1987;8:29-39.
  • Lehman DE, Smith RW. Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis. Foot and Ankle. 1995; 16:535-541.
  • Kuwada GT. A retrospective analysis of modification of the flexor tendon transfer for correction of hammer toe. J Foot Surg. 1988;27(1):57-59.
  • Bartee SL, Midenberg M. A modified arthroplasty procedure for rigid hammertoe. J Foot Surg. 1983;22(1):40-44.
  • Coughlin, MJ. Operative repair of the mallet toe deformity. Foot Ankle. 1995;16:109-116.
  • Gallentine JW, DeOrio JK. Removal of the second toe for severe hammertoe deformity in elderly patients. Foot Ankle Int. 2005;26(5):353-358.
  • Pietrzak WS, Lessek TP, Perns SV. A bioabsorbable fixation implant for use in proximal interphalangeal joint (hammer toe) arthrodesis: Biomechanical testing in a synthetic bone substrate. J Foot Ankle Surg. 2006;45(5):288-294.
  • Boyer ML, DeOrio JK. Transfer of the flexor digitorum longus for the correction of lesser-toe deformities. Foot Ankle Int. 2007;28(4):422-430.
  • Bouché RT, Heit EJ. Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: Preliminary observations. J Foot Ankle Surg. 2008;47(2):125-137.
  • Shirzad K, Kiesau CD, DeOrio JK, Parekh SG. Lesser toe deformities. J Am Acad Orthop Surg. 2011;19(8):505-514.
  • Witt BL, Hyer CF. Treatment of hammertoe deformity using a one-piece intramedullary device: A case series. J Foot Ankle Surg. 2012;51(4):450-456.
  • Catena F, Doty JF, Jastifer J, et al. Prospective study of hammertoe correction with an intramedullary implant. Foot Ankle Int. 2014;35(4):319-325.
  • Kramer WC, Parman M, Marks RM. Hammertoe correction with k-wire fixation. Foot Ankle Int. 2015;36(5):494-502.
  • Basile A, Albo F, Via AG. Intramedullary fixation system for the treatment of hammertoe deformity. J Foot Ankle Surg. 2015 May 28