The hammertoe deformity usually consists of a hyperflexion deformity of the proximal interphalangeal (PIP) joint. Hyperflexion simply means too much downward bend at the joint. The PIP joint is the joint between the first bone of the toe and the second bone of the toe. Clawing of the lesser toes is a combination of the hammertoe deformity, plus hyperextension of the metatarsal phalangeal (MTP) joint. Hyperextension simply means too much upward bend at the joint. The MTP joint is the joint that makes up the ball of the foot.
Causes of Hammertoe
Hammertoes are usually the result of a shoe that is too pointed. Combine pointed shoes with high heels, and the foot is constantly being pushed downhill into a wall – and the toes are squished like an accordion all the time.
Symptoms Associated with Hammertoe
Eventually, toes that are squished day after day become fixed in that position and will not straighten out. When this occurs, pressure builds in three places:
- at the end of the toe
- over the PIP joint
- and under the MTP joint
This causes painful calluses to develop due to pressure from the shoe.
Diagnosis if these two conditions is obvious from the physical exam. In some cases it is important to check to make sure no other nerve problems are to blame for the condition – and special tests may be required.
Treatment of Hammertoe
Treatment depends on how far along the process is. Early in the process, simply switching to shoes that fit properly may stop the process and return the toes to a more normal condition. If the condition is more advanced, and the toes will not completely straighten out on their own – a contracture may exist. Pressure points and calluses caused by the contractures can be treated by switching to shoes which have more room in the toe, or by placing pads over the calluses to relieve the pressure.
If all else fails, surgery may be suggested to correct the alignment of the toe. One of the most common procedures to correct the contracture of the PIP joint in hammertoe deformities is an arthroplasty of the PIP joint. In this procedure an incision is made over the PIP joint. The end of the proximal phalanx is then removed – to shorten the toe and relax the contracture around the joint. The toe is then either held with pins, or sutures, in the straight position until a false joint develops.
After surgery, you will usually be fitted with a post-op shoe. This shoe has a stiff, wooden sole that protects the toes by keeping the foot from bending. The metal pins are usually removed after two or three weeks.