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Hammertoe

What is a hammertoe?

A hammertoe is often used to refer to any contracture or abnormal bending of the toes. Specifically a hammertoe is a contracture of a specific joint, the proximal interphalangeal joint (the PIPJ), a mallet toe is a contracture of the distal joint (DIPJ) and a claw toe is a contracture of both these joints. Hammertoes can be somewhat flexible, reducible or can become rigid over time.

Symptoms:

Often the joints of the toe are not themselves painful but the resulting deformity can lead to:

  • Painful rubbing irritation between toes
  • Painful callouses/corns from rubbing in shoe gear
  • Difficulty fitting into shoes
  • Metatarsalgia or pain in the ball of the foot (from retrograde buckling)

Causes:

  • High arches
  • Ligamentous laxity
  • Flat feet or excessive pronation
  • Muscle, tendon and ligament imbalances
  • Gait compensations
  • Neuromuscular diseases

Diagnosis:

Bunions can be diagnosed from visual inspection. X-rays are needed for detailed assessment of the severity and nature of the hammertoes, associated deformities as well as for planning of any surgical treatments.

Treatments:

  • Extra depth/volume shoes
  • Custom orthotics: these can incorporate features to optimize joint function while also reducing excessive arch collapse that leads to joint imbalances.
  • Padding
  • Splints
  • Toe spacers
  • Surgery. Not every hammertoe requires surgery. For those that do, there are numerous procedures and your doctor will have to carefully assess the severity, nature, causes of your hammertoe as well as your specific activity level and goals to determine the proper procedure.