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Hammer Toe

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What is Hammer Toe? A toe that is bent permanently downwards, a result of pressure from footwear.

Hammertoe and mallet toe are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight. The type of shoes you wear, foot structure, trauma and certain disease processes can contribute to the development of these deformities.

A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in your second, third and fourth toes.

Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you might need surgery to get relief.

Definition:‘symptomatic/nonsymptomatic, fixed/mobile sagittal plane lesser toe deformity characterised by dorsiflexion of proximal phalanx at metatarsophalangeal joint, plantarflexion of intermediate phalanx relative to proximal phalanx and (variably) neutral, dorsiflexion or plantarflexion of distal phalanx relative to intermediate phalanx; associated ,metatarsal head may become plantarflexed and load-bearing due to pressure from dorsal orientation of base of proximal phalanx’ (Mooney, 2009:401).

Reflection: These structures have a cauliflower appearance with small black dots which represent blood supply, however some appear flesh coloured and are not as easy to identify. They are often confused with corns, as on occasion some appear to have clearly defined borders (Bristow and Turner, 2009:191).

Clinical Features: Such deformity occurs in the sagittal plane and therefore creates dorsiflexion of the proximal interphalangeal joint (P.I.P.J.). This deformity may be painful with the frequent presentation of a dorsal corn due to repeated trauma from footwear. Other clinical features may include inflammation at the affected joint.

Cause: This problem is thought to be primarily associated with the wearing of ill-fitting shoes. Extensor muscles are thought to reduce their range of normal extension resulting with the contraction of the tendon and possible damage to the proximal interphalangeal joint due to repeated trauma. (Klenerman et al., 1976).

Management: To reduce contraction and pressure at the proximal interphalangeal joint, toe splints and toe props are utilised to reduce the angle of flexion, to promote comfort and reduce shearing over and at the joint. With the reduction of dorsiflexion, the foot should be better accommodated in the footwear but footwear also needs review. Permanent internal fixation of the P.I.P.J. is a common surgical procedure undertaken for the correction of this condition (Hyer and Scott, 2012).

References: Hyer,C.F. and Scott, R.T. (2012) ‘Current and Emerging Insights On Hammertoe orrection’. Podiatry Today.Vol.25(2). Online Available: http://www.podiatrytoday.com/current-and-emerging-insights-hammertoe-correction

Accessed (25/07/15).

Klenerman, L. ; Nissen, K.I. and Baker, H. (1976) ‘Common causes of pain in the region of the foot’. In Klenerman, L. (Ed.) The Foot and its disorders. London: Blackwell. p. 131-177.

Mooney, J (2009) Illustrated dictionary of Podiatry and Foot Science, Churchill Livingstone Elsevier, London.