Fearing Pins with Bunion and Hammertoe Surgery

Today I got a question from a patient who is thinking about surgery for bunions and hammertoes. She explained that a friend of hers had a similar surgery. She said that her doctor pinned the hammertoes. In addition, he put a plaster cast around the front half of the foot. Her friend was wearing a surgical shoe, but that the pins and cast would have to stay in place for at least 5 weeks!

So the question is… is it necessary to have pans sticking out of the end of the toes after you have hammertoe surgery. The other question is how long does it take for someone to really recover.

There are many ways to fix hammertoes. In the cases described here, the patients also had bunions and decided to have surgery to fix both of those problems at the same time. Many times as a bunion forms, the big toe will move over against the second toe and push the toe out of alignment. This causes the hammertoe deformity.

If this is the case, fixing the hammertoe alone is not a good idea. Without fixing the bunion that is pushing into the second toe, the hammertoe deformity is likely to develop again.

When the hammertoe is straightened, something has to be done to keep the toe in alignment while it heals. One way to do this is to drive a pin in the end of the toe through all of the bones in shish kebab fashion. I personally don’t like this method. Although it is simple and inexpensive, it does have additional risks.

A pin sticking out of the end of the toe is a portal for bacteria and can lead to an infection. Whenever you walk or move the foot, the skin moves back-and-forth across the pin. Over time, the bacteria that normally grows on the skin can work its way down the pin as it pistons relative to the skin.

Because the pin is driven into the bone, this can lead to bone infection. Bone infections, also known as osteomyelitis, are very difficult to treat and often lead to amputations. This is a very serious complication.

A better way to correct a hammertoe is to put an implant in the joint that is corrected when the foot surgeon out the toe. This implant is completely contained within the toe. There is no exposed tendon and no additional risk of contracting an infection. There are both absorbable and nonabsorbable implants available to surgical podiatrists for this procedure. The nonabsorbable implants are typically made of titanium or surgical stainless steel.

These implants do cost more than the pin that’s typically left sticking out of the end of the toe. Medicare will not pay for these types of implants. For my patients, this is no longer a problem is I have decided to opt out of Medicare. I believe it’s important to make sure the patient has the best treatment available, not just the cheapest treatment.

Regardless of which method you and your foot doctor choose, it does take about six weeks for the corrected hammertoe to heal. It is necessary to wear either a surgical shoe or a fracture walking boot while you recover. Most people can walk while they are recovering. It’s not always necessary to use crutches.

If the pin is sticking out of the end of the toe, it is typically necessary to leave in place anywhere from four to six weeks. Much of this depends on the patient’s age, how well the person is recovering, and whether or not an infection develops.

Although this can be an inconvenience, there are other methods. It’s important to discuss your expectations and desired activities with your foot surgeon before you have any foot surgery. Making sure that you understand what will be required for you to recover, to make sure that you can get back to activities you enjoy as quickly as possible.

Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.

What is a Bunion?

A bunion is a nothing more than a bump or enlargement of the bone and joint at the base of the big toe. This joint is called the first metatarsophalangealjoint (MPJ). A bunion forms when the joint becomes misaligned and the bone or soft tissues at the big toe joint start to move out of place. What happens is that the big toe starts to bend over toward the other toes. This causes the bone to stick out. The soft tissues that are covering that bone Denbigh come irritated red and inflamed. This causes a painful knot of bone. Because this joint carries the majority of the body´s weight while walking, bunions can become extremely painful. Eventually the big toe joint itself may become arthritic, stiff and sore. This can make walking and fitting into shoes extremely difficult.


Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.

Do I Need Surgery for Arthritis in my Big Toe Joint?

Today I had a question from an active 28 year-old named Jennifer. She has a very active 3 year old son she chases about, but she gets pain and stiffness in the big toe joint. She says its worse when she crawls around on the floor kneeling, squatting, and playing with her little boy. She says he's into everything, but she loves watching him learn.

She thought she had a bunion and went to see a foot doctor who told her it was arthritis. And she needed foot surgery right away. Although this assessment was close, it was wrong.

She came in to see me for a second opinion.

Now, I will admit that she does have a little arthritis in the big toe joints. I will admit that one is worse than the other. I will even admit that I (or any foot surgeon) could make it look different on xrays. Maybe even look better on xray. But no guarantee it would feel better. At least not by New Years.

Jennifer has a condition called hallux limitus or hallux rigidus. This happens when there is restricted motion and the big toe doesn't bend up as far as it should. Because of this, the joint starts jamming and develops arthritis. Eventually, bone spurs start to develop on top of the joint. With time it will get worse. The cartilage can even get worn away over time.

Someone recommended that she have joint replacement surgery to put an implant in to replace the worn joint. Good idea, but not when she is committed to taking care of a 3 year old. I recommended she get some super-stiff Dansko Clogs from ZUMFOOT. With these she can walk without pain because the big toe won't be forced to bend and thus it won't jam anymore.

For her this was a good solution. She can can now walk without pain and wait until the timing is better. It won't get worse fast, and she can wait until the little one starts school.

Eventually she will have surgery. But I truly believe that unless the condition is going to get significantly worse, you should have foot surgery when it fits your lifestyle best.

Foot surgery can help many conditions, but the amount of disruption to your daily routine is elective...just like the surgery.


Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.