Hammertoes/Toe Deformities

hammertoes

Anatomy

The 2nd, 3rd, 4th, and 5th toes each contain 3 bones known as the proximal phalanx, middle phalanx, and distal phalanx. The proximal and middle phalanges meet to form the proximal interphalangeal joint while the middle and distal phalanges meet to form the distal interphalangeal joint.

Condition

A hammertoe results when there is a flexion contracture at the proximal interphalangeal joint (PIPJ). This leads to prominent bone at the PIPJ on the top of the toe and can also lead to pressure at the tip of the toe.

A mallet toe results when there is a flexion contracture at the distal interphalangeal joint (DIPJ).  This leads to prominent bone at the DIPJ on the top of the toe and can also lead to pressure at the tip of the toe.

A claw toe results when there is a flexion contracture at both the proximal and distal interphalangeal joints. This leads to prominence at both the PIPJ and DIPJ on top of the toe and can also lead to pressure at the tip of the toe.

Symptoms

  1. Pain, generally sharp and throbbing in nature, is commonly felt on top of the involved joint and can also be felt at the tip of the toe
  2. Numbness in the toe
  3. Corn formation on top of the involved joint
  4. Callus formation at the tip of the toe
  5. Swelling
  6. Limited ability to wear shoes comfortably
  7. Limited ability to participate in physical activity

Diagnosis

Diagnosis is made by a comprehensive foot exam by Dr. Stewart along with x-rays of the foot.

Common causes

  1. Shoes DO NOT cause toe deformities, yet if the shoes do not fit properly they will aggravate toe deformities
  2. Congenital/inherited predisposition to the deformity
  3. Structural bone deformity
  4. Imbalance of tendons and muscles
  5. Flatfoot deformity

Treatment

Conservative treatment options are available for toe deformities. If pain and limitation continues after all conservative care has been exhausted, then surgical intervention is generally recommended.  Dr. Stewart only recommends surgery for pain and limitation and never recommends surgery for cosmetic reasons.

Conservative treatment for toe deformites include:

  1. Deeper and wider shoe gear
  2. Custom foot orthotics
  3. Ice along the toe 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
  4. Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
  5. Steroid injections
  6. Avoidance of flip-flops, flats, and barefoot walking
  7. Supportive open shoe gear to keep pressure off of the prominent bone
  8. Supportive shoe gear including a motion control running shoe such as Brooks, Aasics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
  9. Padding over the prominent joint
If all conservative care fails, then surgical intervention is recommended. There are many surgical options for toe deformities and if surgery is indicated, Dr. Stewart will choose the right procedure for you. The goal of surgery is to reduce the prominent joint, taken pressure off the tip of the toe, and prevent recurrence of the deformity. The surgical recovery depends on the procedure performed.

Surgical treatment for toe deformites include:

  1. Simple removal of the prominent bone and joint (arthroplasty)
  2. Interphalangeal joint fusion (arthrodesis)
  3. Tendon release (tenotomy)
  4. Fusion of toes (syndactyly)

Schedule an Appointment Hammertoes/Toe Deformities