Before your health insurance company will deem hammertoe surgery medically necessary, you will need to attempt more conservative, non-surgical treatments. These treatments work best for people with flexible hammertoe, a less severe form of the condition in which the deformed toe joint can still be straightened manually. Learn more about the procedures used to treat hammertoe, and discover what criteria insurance companies use to determine if hammertoe surgery is medically necessary.
Non-Surgical Hammertoe Treatments
Your insurance company will probably want you to attempt non-surgical hammertoe treatments for at least six months before they will agree to pay for surgery. These treatments can include padding the top of the deformed joint with non-medicated toe pads that can protect the toe from rubbing painfully against the shoe. You will need to wear properly fitted, comfortable shoes that leave a gap of at least half an inch between the longest of your toes and the tip of the shoe. Refrain from wearing any heels that are higher than about two inches. Make sure your shoes are always appropriate for whatever you’re doing.
Your doctor and insurance company may want to try analgesic or anti-inflammatory drugs to relieve the pain and swelling of your hammertoe before resorting to surgery. Cortisone injections may help to ease pain in the deformed joint. A custom-made orthotic insert can help keep your hammertoe from worsening and can ease discomfort during walking. If your hammertoe can still be straightened, a splint can help hold it in the right position. But if your hammertoe cannot be straightened and padding, pain relievers and footwear all aren’t enough to relieve your pain and restore function, then it may be time to resort to surgery.
Determining Medical Necessity for Hammertoe Surgery
Your insurance company will probably deem your hammertoe surgery medically necessary if your hammertoe causes you pain and difficulty with walking, persistent pain or an ulcer or corn at the top of the joint. You will have to have tried the full range of non-surgical treatments, including padding the toe, using a splint if possible, taking pain medication and wearing appropriate footwear.
If you have tried all of these things and your hammertoe is still causing you significant pain and discomfort, your health insurance company will probably deem surgery medically necessary. Your insurance won’t pay for hammertoe surgery for cosmetic reasons. They won’t pay for surgery to correct a flexible hammertoe that can be held straight with a splint, unless the splint isn’t working out for some (non-cosmetic) reason.
There are many options for hammertoe surgery, so talk to your insurance company and find out what they’re willing to subsidize. K-wires, surgical pins and implants can all help surgically correct your hammertoe. The specific procedure that’s right for you will depend on the extent of your hammertoe deformity, and whether there are any other problems with your foot.
If your hammertoe is deemed mild, you may not need an implant. Your doctor may be able to perform a procedure known as a tendon transfer, in which the tendons of the toe joint are moved from the bottom of the toe to the top. This procedure can pull the toe straight. A moderate deformity might be fixed by surgically removing the toe joint and allowing the bones to heal back together. A severe deformity will require both surgical reconstruction of the joint and the insertion of pins, K-wires or implants to hold the toe steady during recovery.
Recovery from hammertoe surgery can take up to six weeks, though you should be able to return to normal activities after one or two weeks. You will not be able to bend your toe after the procedure; it will be permanently straightened. If you have a bunion, corns on the other toes, a dislocation of the toe joint where it connects to the foot, or other foot problems, your doctor will probably want to perform surgery to correct these at the same time as your hammertoe surgery. These procedures may also be deemed medically necessary, especially if they are necessary to restore function and keep the hammertoe from coming back.
Getting your insurance company to pay for corrective hammertoe surgery is definitely possible. If you and your doctor have tried non-surgical treatments with no luck, your health insurance company will most likely deem hammertoe surgery a medical necessity. Most people who receive hammertoe surgery are back on their feet six weeks later with a new lease on life and no regrets.