MiQuestions
  • What is hammertoe and what causes hammertoe?
    Dr. Robert Anderson Watch Video »

    So, the question comes up, what is a hammertoe? Or, why did I get a hammertoe? Why me? And, there are many different names or terms for a hammertoe. So, we have hammertoes and we have clawtoes. And, a hammertoe is typically where the toe will develop what we call flexion contracture at the PIP joint, so it is that joint in the middle of the toe that sort of becomes stuck in that position. A claw toe not only has a hammertoe deformity, but then tends to, what we call, hyperextend at the MP joint, which is the next joint down towards the middle of the foot. So you have a claw toe and a hammertoe. You can also develop something that is called a mallet toe, and a mallet toe is at the last joint of the toe that can also develop a flexion deformity or a flexion contracture. Any one of these deformities can develop in a single toe, and they can occur in combination. And then the question is what causes them? And there are a lot of different reasons to develop a toe deformity. It can be arthritis, it can b a nerve related problem, something due to spasticity. It can be due to a rheumatologic condition. It can even be due to an injury. So, all of these things can create a toe deformity, like a hammertoe. And, of course, there are genetic reasons for it too. So, it could be just bad luck. You just had the wrong genes and that’s the reason that you developed that particular deformity.

  • How do you evaluate your patient's hammertoe?
    Dr. Christopher Hyer Watch Video »

    When we first interview a patient with hammertoes, we have to spend a lot of time finding out when the hammertoe or what about the hammertoe bothers the patient – if there is pain during certain activities or in just specific types of shoes – and whether the hammertoe is progressing or getting worse over time. We’ll also then look at the hammertoe and see if it is still flexible, meaning that I can manipulate the toe and straighten it, or if the hammertoe is actually stiff or rigid, which means that it won’t flatten down with manual pressure. We are then also going to see how the hammertoes function with the patient standing and walking, and whether they can grip with the toes, simulating some sport activities and recreational activities.

  • How do you determine if surgery is right for the patient?
    Dr. Robert Anderson Watch Video »

    When a patient feels as though they need surgery for their hammertoe deformity, it is important for the patient and the surgeon to sit down and discuss whether they are a good candidate for that correction. Obviously, they need to have skin that is of a condition that will heal with surgical intervention. They have to have adequate circulation, good pulses in their feet. We would tend to shy away from patients who have severe diabetes, or potentially some severe neurological problems, or other medical reasons or conditions that may prohibit surgery. Once we’ve determined that the patient is a surgical candidate – they have good pulses, good soft tissue and skin condition at the level of their toe to allow for surgical correction of their hammertoe deformity, then we would sit down and discuss the specific surgery and the use of the MiToe™ implant versus that of a k-wire.

  • What can the patient expect with the MiToe™ surgery?
    Dr. Robert Anderson Watch Video »

    When a patient elects to proceed with surgery for correction of a hammertoe deformity utilizing the MiToe™ implant, it is really a smooth and fairly speedy process. We will usually pick a particular date to proceed to the surgery center or outpatient facility. They will meet with the anesthesiologist. They will have light sedation. They will usually have, what is called an ankle block where the foot is numbed for a short period of time to allow the surgery to be performed. The surgery will often take 20 minutes, if it is just an isolated hammertoe that is being corrected. The way that I manage the patient post-operatively is with a small dressing that is placed around the toe and the front of the foot that is typically removed at about 1-2 weeks time. The patient is allowed to fully weight bear on the foot immediately utilizing some type of post-operative shoe or post-operative sandal. We typically remove any stitches that were placed by two weeks after the surgery, and at that time, the patient is allowed to shower and even swim. Assuming that there is no wound healing issues and minimal swelling, we often times allow our patients to get into their accommodative shoe wear - athletic shoes, or clogs, or Crocs – even after that 2 week mark.

  • What is the typical recovery time after a MiToe™ procedure?
    Dr. Robert Anderson Watch Video »

    The whole recovery process with the use of a MiToe™ implant is a fairly quick one, again assuming that we’re doing an isolated hammertoe. As I mentioned before, a lot of patients are having additional procedures done, which may prolong their recovery to some degree. But, if you’re talking about correcting an isolated hammertoe deformity with a correction and implantation of a MiToe™ implant, the recovery process really is quite easy, quite simple. Once the stitches are removed at 2 weeks, we do allow the patient to return to a shoe that is accommodative – that has enough room to manage any residual swelling. They can increase their activity as quick as they like, whatever their symptoms allow. They can get back to work within a fairly short period of time. They can get back to their sport within a rapid period of time. So, again, the recovery process utilizing the MiToe™ implant is a fairly expeditious one.

  • What exactly is the MiToe™ implant?
    Dr. Robert Anderson Watch Video »

    When we consider surgery for the hammertoe deformity, we’ll often times consider the use of the MiToe™ implant. People want us to describe – what is this implant – is there a concern about having this implant in my toe forever. And there really isn’t. It is a metal implant; it is a stainless steel implant. It has been used in similar conditions in the body for literally the last century with no concerns for long-term implantation. It is a small implant that is sized specifically for your toe. It has a threaded end and it has a barbed end that allows the surgeons to basically remove the deformity and then maintain the toe in proper position afterwards with secure fixation on both sides of that joint.

  • Why would you recommend MiToe™ to your patients?
    Dr. Robert Anderson Watch Video »

    I recommend the MiToe™ implant for my patients undergoing hammertoe corrective surgery, because I think it offers not only convenience to the patient post-operatively with less swelling, less risk of infection than a wire will have, but also a return to a shoe quicker , allowing them to get back to their daily activities quicker whether it is work related ones or recreational.

  • Why is the MiToe™ the best surgical option for patients with hammertoe?
    Dr. Robert Anderson Watch Video »

    I believe that the MiToe™ implant is the best choice for maintaining correction of a hammertoe surgery because it provides long-term stability, and it maintains the correction despite what external forces may be on the toe, whether it be a recurrent bunion deformity or whether it is shoe pressure. Having that implant in the toe keeps that toe in whatever position you want. And , of course, it is a convenience to the patient, and decreases the risk of infection, which, is a concern for a number of patients, particularly when they have other medical conditions.

  • What are K-wires, and how are they used?
    Dr. Robert Anderson Watch Video »

    K-wires can be used for the correction of a hammertoe that is undergoing surgical correction. They are small, slender, stainless steel pin that are placed into one half of the bone and out the toe at the other end. And it basically holds the toe in good position, and it has been used for many, many years with relatively good results. But, again, that pin has to remain out of the end of the toe for subsequent removal. So, you have this pin hanging out of the end of the toe that may catch on socks, it may catch on the carpet. It runs the risk of getting loose and infected. And often times the surgeon will have to put a little ball or a rubber cap over the end of the toe to keep it from getting snagged, and that adds just more bulk and inconvenience to the patient.

  • What is the patient’s experience with K-wires like?
    Dr. Robert Anderson Watch Video »

    K-wires in the correction of hammertoe deformity can certainly work. They’ve been used for years, and they can be successful. However, we have found over our years of experience that they do run the risk of infection; they do have a tendency to have more swelling. When the wire is removed from the toe, there is a significant risk of having a recurrent deformity – it may not be a recurrent hammertoe but a deviation of the toe from one side to the other. For that reason, we have found the use of a MiToe™ implant to be beneficial.

  • Why do patients typically hate K-wires?
    Dr. Christopher Hyer Watch Video »

    So some of the comments and feedback that we get with K-wires from patients is, for the most part, negative. Patients do not like having these wires sticking out of their toes. They’re very fearful of getting them caught on clothes and bedsheets and blankets. They’re typically very fearful about their home pets and personal pets getting caught on the wires or tripping over the wires. I have also had some patients that have gotten cut by the wires. When the protective cap that we put on the end of the wire will sometimes come off, I’ve had patients get cut on their other leg when sleeping just due to the sharp end of the wire itself. One of the other downsides and complaints that we hear from patients is that, though the wire may keep the toe somewhat straight, it does not prevent the toe from twisting on the wire, and you can get the toe that sometimes rotates one direction or the other , which causes pain in the toe but also causes an unsightly appearance of the toe that wasn’t desired as part of the surgery.

  • How does the MiToe™ implant affect recovery vs. K-wires?
    Dr. Christopher Hyer Watch Video »

    In my experience, with most of my patients, we see a significantly quicker recovery time with the MiToe™ implant versus the K-wire. The way we gauge that is that we see the toe really swells much less and for much shorter time with the MiToe™ implant. We’re able to get patients back into shoes at about 3 weeks with the MiToe™ implant versus about 8-12 weeks in a K-wire situation. Also, what we have is the additional stability of the MiToe™ implant remaining in the toe so the toe is able to continue to heal around that implant for additional strength that we do not have when the K-wire is removed.

  • How long will it take to get back to normal after a MiToe™ procedure?
    Dr. Robert Anderson Watch Video »

    The question comes up, “How long will it take for me to get back to completely normal?” And, of course, that is different from one individual to another. How much surgery did you have? As I mentioned, we often do hammertoe deformity corrective surgery in addition to other surgeries, so your recovery may be prolonged due to the fact that you have had your bunion fixed or you have had other foot deformities corrected at the same time as when your hammertoe has been corrected. In general, we try to get patients back on their feet within the first several days. We try to get them back into their shoewear within the first 2-4 weeks, depending on swelling. Swelling in the foot can last for some time just due to the gravity effect of being on your feet all day can create some swelling concerns that may last for weeks and even into months. But, most of our patients are back to regular activity after an isolated hammertoe deformity correction by 4 weeks, and back to their dress shoe wear by 2-3 months.

  • What are the main benefits of the MiToe™ procedure?
    Dr. Robert Anderson Watch Video »

    I think the patient will find a significant number of benefits by having a MiToe™ implant utilized for hammertoe correction over a K-wire. Again, it is based on my experience, but I have found that cosmetically the toe just looks better – it has less swelling and maintains its position better than one in which the hammertoe was corrected with a K-wire, the K-wire was removed and the hammertoe came back, or created some long term swelling, or what we call molding effect. I find that it is not only one that has a cosmetically advantage, but also convenience – not having a pin sticking out the end of the toe that has to be removed in the office after 4 weeks. Being able to get back to shoes quicker. They can shower and swim quicker, is of significant importance to a number of patients. And I think the safety of the implant over K-wires is important to mention. I find that not having that risk of infection that is often created by having a retained implant is a tremendous benefit to a number of patients, whether they are those that are diabetic and have increased risk of infection or those that may have a total joint replacement in that same lower extremity where the toe is being corrected. We try to reduce that risk of infecting another implant by not having K-wire sticking out the end of the toe. Those are just a few of the reasons that the MiToe™ implant may be of benefit to patients coming into our offices.

  • Why is the MiToe™ your preferred surgical option?
    Dr. Christopher Hyer Watch Video »

    The MiToe™ implant is my preferred implant for most of my patients. The reason for this is that the implant is simple to use for the OR staff and for the surgeon, everything is internal to the toe so we don’t have anything sticking out of the skin that can cause infection or that is a source of pain for the patient, and I’m able to get the patient back into normal shoes and activities much quicker than I can with other implants out there.

  • What has been your experience and success using the MiToe™ implant?
    Dr. Robert Anderson Watch Video »

    We’ve had an excellent track record of utilizing the MiToe™ implant in Charlotte where I practice. The implant has been out for nearly 2 years. It has been used in over 10,000 procedures with excellent success both in the short term and the long term. I have personally done literally hundreds of these implants, and I must say that my patients are very, very happy that they’ve had the implant placed rather than that of a K-wire.

  • How do you determine treatment options including conservative and surgical?
    Dr. Christopher Hyer Watch Video »

    Talking about options is going to be a big part of our conversation with the patient. We’re going to really listen to them about again when there is a problem, when the hammertoe really causes pain and what kind of limitations they’re causing. Key to this is going to be both shoe gear restrictions but also activity restrictions. I’m going to want to know what sports and hobbies they typically like to do, and how the hammertoe is maybe influencing that or affecting that. That will then gauge some of our conversation about care. If we’re catching hammertoes early on, and its just the simple shoe gear change that will get them back to their activities or sports, that may be all that is needed. As we get further down the line, there may be more advanced bracing or padding techniques. Or even a discussion about surgical correction if necessary.

  • Are there risks involved when having a hammertoe surgery?
    Dr. Robert Anderson Watch Video »

    Any surgical procedure has its own risks, and just correcting a simple hammertoe deformity is no different. There are always risks of infection or wound healing problems, recurrent deformity or broken implants. Again, we will offer patients the option of a MiToe™ implant or a K-wire when we do correct a hammertoe. We want the patient to make sure they understand those risks before we do a surgery. We want to ensure that they’ve exhausted all of their non-operative opportunities before surgery as well. It is important for the patient to understand that no matter how simple the procedure is there are always risks that may be associated.

  • What are the risks and benefits of surgical intervention?
    Dr. Robert Anderson Watch Video »

    Any surgery has its risks and benefits, and it is very important for the patient and the physician to sit down with their physician to discuss those risks and benefits before pursuing surgical intervention. Now, not all patients are going to be able to undergo surgery on a foot deformity, or, in this case, a hammertoe deformity. There may be medical conditions that prohibit surgery, there may be certain medications, or inadequate circulation that may prohibit surgery, in which case, patients are best treated by non-operative modalities such as larger shoes or some type of sleeve on the toe itself. No matter how simple the surgery appears to be, there are always those risks of infection or wound healing problems, or recurrences, or failed metal implants or K-wires, so it is very important that the patient understands that before going to the operating room for any type of hammertoe correction.