The last 10 years could be described as the golden age of the intramedullary hammertoe device. Today, there are more hammertoe implants on the market than ever before. Every foot and ankle company markets at least one implant because the revenue opportunity is tremendous. With over a million performed annually and the $1000+ price tag it is easy math to understand why.

The k-wire continues to be gold standard as it is simple and inexpensive but the drawbacks include pin tract infections and high rates of non union and malalignment. Surgeons have used cannulated screws, sutures, and staples in the past but companies have been trying to crack the code for over twenty years and as more distal extremity companies have come in to play the amount of implants has become exhaustive. We will review the major players in the space.

Stryker’s Smart Toe is still widely used and was brought to market in 2011. It was the first to use a memory metal and it is probably safe to say more have been implanted than any other design. They have since developed the Toe Tac Express, a PEEK implant with disposable cup/cone reamers.

Wright developed a silastic hammertoe, the Swanson, in the early 2000’s but to combat the Smart Toe they developed the Protoe VO which has been knocked off by many companies making small iterations to the Christmas tree middle phalinx fixation design. Through its multiple acquisitions Wright owns the original allograft implant, Tenfuse, and the Phalinx, which seems to be their front runner.

Zimmer/Biomet’s Nextra implant is a two piece implant with multiple options and special reamers. Gramedica has recently followed suit with a two piece implant but the first was Stayfuse, developed by Tornier in 2008.

Arthrex is best known for its absorbable Trim-it pins. Their first metal implant, Retrofusion, was very similar to Wright’s Protoe C2 but their most recent implant, Dynanite, is claimed to be the first cannulated Nitinol implant.

Paragon28 developed the Hammertube, a PEEK tube coated with porous titanium plasma spray. And they are the first to address the hammertoe with a novel soft tissue fixation implant, the TenoTac.

While all of these work time will tell which works better than others. We believe MIS will be the next chapter in hammertoe surgery sometimes requiring no fixation at all.