Joint Replacement, Sports Medicine, Spine Surgery, Pediatric Orthopaedics, Neurology, Hand and Foot Surgery

Hammertoes

The term hammertoe refers to a flexion deformity or buckling of the joints within the toes. Depending on which joint or joints are affected, similar conditions known as mallet toes or clawtoes can also occur. These conditions are frequently painful and usually cause considerable difficulty in obtaining comfortable footwear.

Common Symptoms:

As the joint assumes a flexed position, a deformity results which creates a bony prominence that is vulnerable to pressure from the shoe. Constant, repetitive pressure, especially from ill-fitting or constrictive shoes leads to pain over the deformed joint. Symptoms typically occur over the interphalangeal joint (between bones in the toe) but can also occur at the tip of the toe or beneath a metatarsal head (ball of the foot).

Over time, the skin adjacent to the prominent bone becomes irritated leading to the formation of corns and calluses. These are thickenings of the outer layer of skin, which form in an attempt to protect the underlying structures from pressure. In severe cases, inflammation, ulceration, and infection can result, further complicating the condition.

Diagnosis:

A history and physical exam is needed to make the diagnosis of hammertoe deformity. Foot X-rays while the patient is standing also provide useful information in evaluating the deformity.

Treatment Options:

Several options are available for the treatment of a hammertoe deformity. The treatment depends on the nature and severity of the specific condition and the factors that caused it. In the early stages, avoidance of ill-fitting , constrictive footwear, especially high heel shoes, may be effective in reducing symptoms.

  • Periodic trimming of corns and calluses provides temporary relief of discomfort.
  • Various types of accommodative padding or shoes with deeper toe boxes may decrease pressure over bony prominences.
  • Biomechanical abnormalities such as excessive pronation should be evaluated and treated with appropriate orthotic devices.
  • For many patients however these conservative treatments provide only partial or temporary relief of symptoms as they do not correct the deformity.

If conservative methods fail or in more advanced cases, surgery is usually necessary to eliminate symptoms, correct the deformity, and restore function and stability to the toe. Today many good surgical procedures are available for the correction of hammertoes. The specific procedures required will depend on the type and severity of the individual deformity. Hammertoe repair is usually performed on an outpatient basis under local anesthesia with intravenous sedation.