Digital Deformities

Hammertoes

A hammertoe is a contracture—or bending—of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.

Flexible Hammertoes:

These are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammertoes because they are still moveable at the joint.

Rigid Hammertoes:

This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Mallet Toe:

Involves the distal interphangeal joint of the toe. Often associated with a long digit.

Curly Toes (Varus Toes):

Also known as underlapping toes. This is most often congenital or genetic. Usually, curly toes are seen long before a child wears shoes and most of the time effect both feet.

Claw Toe:

Like a mallet toe but also including the proximal phalanx. The middle and distal phalanx are flexed (pointed down) and the proximal phalanx is dorsiflex (point up). This is more severe than a hammer toe. Usually associated with high arch feet and neuromuscular disorders.

Heloma Molle:

Soft corn on the toe. Commonly associated with underlapping 5th toe of deformity of the 5th MPJ. To correct you must remodel the bones of the toes or wear a toe spacer while in shoes.

Brachymetatarsia:

This is a congential deformity that causes a short metatarsal bone in the foot. Most commonly affects the 4th metatarsal bone. This caused by a premature closure of the growth center of the metatarsal or metatarsals. It also can result from trauma. This can cause pain in the adjacent metatarsals, but most of the time doesn’t hurt. Treatment of this problem can be surgical, by callus distraction. Callus distraction is a way to lengthen a bone.

Symptoms

Pain upon pressure at the top of the bent toe from footwear.
The formation of corns on the top of the joint.
Redness and swelling at the joint contracture.
Restricted or painful motion of the toe joint.
Pain in the ball of the foot at the base of the affected toe.

Etiology

abnormal balance of the muscles in the toe
Heredity
Trauma
Arthritis
Wearing shoes that are too tight
Treatment
Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
Wear a shoe with a deep toe box.
If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid heels more than two inches tall.
A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
See your podiatric physician if pain persists.
Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.
Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.
Padding and Taping

Orthotic Devices:

Surgical Options:

Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain.

Severe hammertoes, which are not fully reducible, may require more complex surgical procedures.

Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.

See page on hammertoes for more information.

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