Hammer Toe: Causes, Diagnosis and Treatment
Hammer toe is a condition in which the proximal inter-phalangeal (PIP) joint of the toe attains a position of flexion. See the image below. Extension deformity of metatarso-phalangeal joint may or may not be present. 
Before reading on it would be good to first understand the anatomy of the foot (skip this if you already done so). Commonly involves the second toe. It can be of two types - un-correctable (can not be corrected by passive force)
- correctable (can be corrected by passive force)
Causes of this deformity include - using foot wear with a tight toe box
- abnormally long bones of second toe
- along with hallux valgus
- rheumatoid arthritis
- injury to the toes (fractures and dislocations)
Symptoms of hammer toe include - obvious deformity of the toe (1 or 2 toes are involved usually)
- presence of painful corns and calluses over the toe
- pain is present over the flexed proximal inter-phalangeal joint
- pain is present over the tip of the toe
Treatment can be operative or non-operative. Non-operative treatment is used when - the deformity is correctable
- there is no extension deformity of metatarso-phalangeal joint
- there is no hallux valgus deformity
Operative treatment is done when - non-operative treatment fails
- deformity is passively un-correctable
- presence of hallux valgus and extension deformity of metatarso-phalangeal joint
Non-operative treatment includes - use of proper foot wear (wide toe box)
- use of a soft splint to hold a passively corrected deformity
- soft pads at the site of pain (to reduce the pressure)
Operative treatment includes - A passively correctable deformity is managed by a tendon transfer operation. A flexor tendon is removed and then attached to a extensor tendon. This reduces the flexion force in the proximal inter-phalangeal joint and at the same time increases the extension force on this joint, this corrects the deformity.
- A un-correctable deformity is managed by removal of the head and neck of the proximal phalanx along with the overlying skin. This fixes the deformity and reduces the chances of recurrence.
- Deformity along with hallux valgus requires treatment of both the deformities together.
Surgery is not done for a asymptomatic (painless) deformity.
Frequently Asked Questions
What complications can I expect after surgery?Complications include - residual deformity
- recurrence of the deformity
How can recurrence be prevented? Chances of recurrence are more with correctable deformity. It can be prevented by using correct foot wear (non-constricting wide toe box). How long does it take for complete recovery? It takes 4 to 6 weeks for complete recovery after surgery. During that period you will be required to wear a stiff soled shoe with a wide toe box. I hope the information provided was helpful. If you have any query you can ask me at the contact me page. This page was last updated on 23th June 2009.
Other causes of foot pain... Hallux Rigidus Mallet Toe Bunion Bunionette Flat Foot Haglund-Deformity Heel Pain Sesamoid Fracture Tarsal Tunnel Syndrome Talus Fracture Calcaneus Fracture
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