https://doi.org/10.1177/1071100720904931 Foot & Ankle International® 1–10 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1071100720904931 journals.sagepub.com/home/fai Article Introduction Hammertoe deformities are estimated to affect one-third of the general patient population, making it one of the most common deformities encountered within foot and ankle clinics. 5 Although some are simple, many hammertoes involve complex, multisegmental and multiplanar defor- mities, which makes their initial reduction and mainte- nance of reduction challenging. Symptomatic hammertoes, for example, many times involve soft tissue contractures at both the metatarsophalangeal (MTP) and interphalangeal joints and, in advanced cases, a transverse plane devia- tion of the digit and crossover toe deformity (combined transverse and sagittal plane deformities). 12,16 While ini- tial treatment focuses on control of symptoms through taping/strapping, accommodative padding, shoe modifica- tions, and manual debridement of associated hyperkerato- sis, 3,7,13,15,21 surgery is indicated when nonoperative measures fail. Operative treatment has been shown to be effective in reducing pain and deformity, 1,3,4,6,9,10,13,15,17,18,21,25 but digital 904931FAI XX X 10.1177/1071100720904931Foot & Ankle InternationalAlbright et al research-article 2020 1 Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA 2 Advocate Illinois Masonic Medical Center, Chicago, IL, USA 3 Weil Foot and Ankle Institute, Des Plaines, IL, USA Corresponding Author: Rachel H. Albright, DPM, MPH, Stamford Health, 800 Post Road, Suite 302, Darien, CT 06902, USA. Email: albrightrh@gmail.com Risk Factors for Failure in Hammertoe Surgery Rachel H. Albright, DPM, MPH 1,2 , Moiz Hassan, DPM 1 , Jacob Randich, DPM 1 , Robert O’Keefe, DPM 3 , Erin E. Klein, DPM, MS 3 , Lowell Weil Jr., DPM, MBA 3 , Lowell Weil Sr., DPM 3 , and Adam E. Fleischer, DPM, MPH 1,3 Abstract Background: Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery. Methods: Consecutive patients with a minimum of 6 months’ follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included. Results: Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87). Conclusion: We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery. Level of Evidence: Level III, retrospective case series. Keywords: arthroplasty, hammertoe, recurrence, risk factors, outcome study