Hammer toes

Definition

Malformations of the second to the fifth toe are very frequent. We distinguish the proximal interphalangeal and the distal interphalangeal joint (this is the joint between two phalanges of a toe) at the height of each toe. Both can occur in bending as well as stretching mode.

Fig-79C

The malformations are initially smooth and correctable, but as time goes on, they become stiff and not correctable by manipulation.

 

Symptoms

The burden that the patient mainly experiences by such hammer toes, is the presence of callus-like pavements and/or “corns” on the places where the malformations are in contact with shoes which are too tight, or where overpressure prevails. In this way, toes can also mutually cause friction and wounds.

 

Causes

As main cause, a certain morphological and static dysharmony at the level of the forefoot should me mentioned, often in combination with hallux valgus an/or metatarsalgia. In addition, less common causes should always be considered, as the treatment will probably be different. We have in mind particularly hammer toes in case of a high arched foot, congenital hammer toes, in case of certain neurological disorders, posttraumatic hammer toes,…

Fig-80-griffe-congénitale
Fig-81-griffe-proximale
Fig-82-griffe-distale
Fig-83-griffe-totale
Fig-84-griffe-inversée
Fig-85-orteil-subluxé-muxé-supradductus

 

Treatment

In the absence of infection, wounds etc., an insole or the wearing of specific orthotics in silicone (manufactured by the podiatrist) may initially be tried.

Fig-86

This may be helpful if the hammer toes are still flexible. If, despite all this, the pain and the malformation persist, and there are no signs of infection (clinical and radiological), surgery can be scheduled. This mainly depends on the underlying cause:

  • Resection of the painful protruding lump (arthroplasty)

Fig-87
  • Securing the painful joint, in approximately 15 degrees bending mode (arthrodesis)

Fig-88
  • A tendon lengthening
  • A tendon transfer

Fig-89-Girdlestone

  • An osteotomy of the phalanx or the metatarsal bone
  • In case of a neurological high arched foot, a full correction, often in combination with tarsectomy, should be done. If not, the deviation will relapse.

 

Postoperative policy

Usually, we don’t place a pin, which would be removed during the consultation after 4 weeks. We only do this in specific cases. This removal during the consultation is not painful and somewhat similar to a blood sample. Depending on the kind of surgery that was done, the postoperative course consists of almost immediate partial to full weigth bearing in a special postoperative shoe for 4 weeks.

This surgery can easily take place in day hospital. Sometimes, a toe remains swollen for 6 to 12 months, and this should not alarm you. It is important, however, to mention it in a follow-up consultation.

For more information on the care, the disability, etc., please read the information leaflet concerning the pathology of the forefoot.