SOME MEDICAL FACTS
Description of Hammer Toe
A hammer toe or contracted toe is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer. Mallet toe is a similar condition affecting the distal interphalangeal joint.
Claw toe is another similar condition, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint, combined with flexion of both the proximal and distal interphalangeal joints. Claw toe can affect the second, third, fourth, or fifth toes. Onset is gradual.
Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich’s ataxia.
Doctors diagnose hammertoe by examining your feet to confirm that a toe is bent at the middle joint and the muscles are contracted, causing the end of the toe to point downward. Hammertoe may affect more than one toe on the same foot—for example, the second and third toes—and this condition may develop on one or both feet.
Often, your doctor can confirm the diagnosis in a physical exam. If hammertoe has caused a significant change in the bone structure of your toes or foot, or if your symptoms suggest that there may be nerve irritation, called a neuroma, he or she may recommend diagnostic imaging such as x-ray, MRI.
The fundamental problem is a chronic, sustained imbalance between flexion and extension force of the lesser toes from intrinsic forces, extrinsic forces, or both. Hammertoe deformity primarily comprises flexion deformity of the PIP joint of the toe, with hyperextension of the MTP and DIP joints.
When a foot’s second ray is longer than the first and shoe wear does not fit correctly, flexion of the PIP joint occurs to accommodate the shoe. This length difference also causes MTP synovitis to develop from overuse of the second MTP joint. Attenuation of the collateral ligaments and plantar plate results, and the MTP joint hyperextends and may even progress to dorsal subluxation or dislocation. Rheumatoid arthritis causes hammertoe deformity by progressive MTP joint destruction, leading to MTP joint subluxation and dislocation.
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Corticosteroids & Toe Splints
Can assist in straightening the toes but it is treating a symptom not the cause. The problem will always return unless the base cause of the problem is addressed.
Steroidal & Pain Medications;
Can offer temporary relief from the pain associated with Hammer Toes but it is not a solution to the problem.
Invasive Surgery: “Last Resort”
If your hammertoe has become fixed (stiff), there are two options for treatment. Joint resection can be used to treat the fixed hammertoe. In this procedure an incision is made over the top of the toe. Ligaments and tendons may be cut to help with straightening the toe. The end of the bone is removed to allow the toe to straighten completely, and pins are temporarily used to hold the toe straight. The pins are usually removed three to four weeks after the surgery.
Fusion can also be used to treat the fixed hammertoe. In this procedure, the ligaments and tendons are cut to help straighten the toe. The ends of the bone are cut and the toe is straightened. Pins, screws or other implants can be used to keep the toe straight while the bone ends heal together.
It is normal to have swelling after surgery. It may take up to one year before the swelling resolves.
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