Hammer toe

What is a hammertoe?

Hammer toe is the most common deformity of the toes of the foot. It is characterised by flexion of the proximal phalangeal joint, extension of the distal phalangeal joint and slight extension of the metatarsophalangeal joint. The peripheral phalanx of one toe is permanently bent towards the ground. As a result, a painful callus occurs both on the dorsal surface of the toe from the pressure of the shoe and on the tip of the toe from the friction of the toe against the ground when walking.

What are the characteristics of the hammertoe?

This condition can occur at any age, but it is more common in older women. It can affect any finger, but it usually occurs on the 2nd finger, followed by the 3rd finger in frequency. Pathologically, the disease is caused by muscle imbalance and excessive traction of the extensor tendons. It is worth noting that heredity plays an important role in the occurrence of hammertoe. Also, other predisposing factors include:

The use of narrow shoes with high heels
Neurological diseases (Charcot-Marie-Tooth disease, cerebral palsy)
Rheumatoid arthritis
Psoriatic arthritis
Diabetes mellitus
Finger injury.

Often, coexistence with a sore big toe (knuckle) is observed.

What are symptoms of hammertoe?

The deformation caused by the condition results in the formation of a callus, which causes severe pain, on the dorsal surface of the fingers due to the friction of the shoe. The disease has a progressive development. In the initial stages, the deformity is flexible and self-corrects in plantar flexion of the foot. In advanced stages, the deformity becomes rigid due to soft tissue shrinkage and is not corrected by plantar flexion. The diagnosis is clinical and radiographs of the foot have a secondary role.

How is it treated?
Conservative Treatment

Treatment is initially conservative. In flexible deformities, special narthexes can be used to help the toe stay in its anatomical position. It is necessary to use comfortable, wide shoes and avoid high heels.

Surgical intervention

In rigid deformities, surgery is often required. This follows depending on the extent of the deformity and the co-existing conditions of the foot, various surgical techniques can be applied. Where the deformity is flexible and conservative treatment has failed, tendon transfers of the flexors and extensors of the toe are applied. In another case where the deformity is rigid and conservative treatment has not had the desired results, the head of the proximal phalanx may be removed and tendonotomies and tendon transfers may be performed. Also, if there is severe involvement of the metatarsophalangeal joint, extensor tendon lengthening, tenotomies and surgical release of the pouch may be performed. In severe deformities, arthrodesis of the proximal phalangeal joint may also be performed. In a possible case where there is a hammertoe of the second toe due to severe big toe pain, it may be necessary to arthrodesis the first metatarsophalangeal joint as well.

The surgery may be performed as day surgery, under general or regional anaesthesia. After 15 days after surgery, the sutures are cut. Post-operatively, patients wear a special metatarsal unloading splint and unloading is recommended for a few weeks.

The orthopaedic surgeon, Dr. Antonios Pettas, was responsible for the foot and ankle surgeries at Norrtälje Hospital in Stockholm. He has many years of experience, with a high success rate of operations contact him for a personalized diagnosis and treatment.

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