Hammertoe

Hammertoe deformities are very frequent toe deformities and can affect the second to fifth toe. Each toe consists of 3 different bones connected by small joints, stabilised by a complicated mechanism of ligaments and tendons. Should this sophisticated system destabilize, the result can be a deformity of the toes, such as hammertoe, mallet toe and claw toe. These malformations, most commonly caused by unsupportive footwear, are characterized by painful bent toes.

Patients have problems wearing shoes because of painful callus on top of the toe or at the tip of the toe. Very often a hammertoe deformity comes along with a hallux valgus deformity, splayfoot and metatarsalgia. Over time a hammertoe can develop into a luxation of the toe at the level of the midfoot joint (MTP joint).

In some cases a hammertoe is not painful, thus treatment is not necessary. If a hammertoe becomes painful treatment is advised.

In those cases I will advise you to do an x-ray of your foot in order to see if there are any other foot deformity present. An examination of your foot will show me what kind of toe deformity you have and if it is still flexible or not.

Treatment options are either conservative non-surgical or surgical treatment. Non-surgical treatments consist in advising you which shoes to wear, special foot and toe exercises, insoles or orthotic devices.

Very often though a surgical procedure will be necessary to alleviate the pain. Depending on the degree of the deformity I will perform a variety of different procedures advising you individually on your situation. Those options include minimally invasive surgical procedures, tendon lengthening or fixationi of the toe with a resorbable pin. All those procedures can be done in local anesthesia in a day care setting. After surgery you have to wear a special shoe for up to four weeks depending on the surgery.

Why do I have a hammer toe?

Hammer toes are a leading cause of pain in the foot. The pain from hammertoe is caused by friction against the shoe.

Hammer toe is characterized by a permanently bent interphalangeal joint. This curvature causes the toe to resemble the shape of a hammer. Shoe pressure caused by hammer toe leads to callus formation or inflammation on top of the bent joint; causing pain.

What are the reasons for the formation of a hammer toe?

Toes and their corresponding joints are stabilized and held in position by the small muscles located in the forefoot. With aging, the muscles of the foot lose their strength and coordination, causing changes of the toe position and malformation of the toes. Frequently, a hammer toe occurs in conjunction with a hallux valgus deformity, or bunion. In the presence of a hallux valgus deformity, the first toe (the big toe) “slants over” and closes in on the second toe, leaving no space for the latter and causing it to “pop up,” losing its balance and form.

Another cause of hammertoe is the weakening of the joint capsule of the metatarsophalangeal joints, or the joints that run between the toes and mid-foot bone. With age, but sometimes also after an injury, tears of the joint capsule on the ball of the foot develop, which has two major effects:

instability of the metatarsophalangeal joints; and
an imbalance of the muscles of the toes. Further, tears of the joint capsule are by themselves painful and uncomfortable, and which add to the discomfort of a hammer toe.

Conservative Treatment of Hammertoe

In the early stages of a hammer toe, physiotherapy and professional insoles help.

Surgical Treatment of Hammertoe

In case of severe deformities, surgery which is performed under local anaesthesia is advisable. If an additional hallux valgus deformity is present, it can be corrected during the same operation.