Hammer toe deformities are one of the most common toe deformities. They can affect all toes except the big toe, but are most commonly diagnosed in the second and third toes. They also often occur together with Hallux valgus.
With this deformity, the toe does not lie flat against the ground but remains bent upwards. This leads to the formation of calluses on the top of the toe.
As with all foot deformities, it is important to understand the anatomy of the affected area to comprehend what is happening and why. All toes except the big toe are composed of three phalanges, thus having three joints: two between the phalanges and one connecting the toe to the metatarsal bone. This deformity occurs at the proximal interphalangeal joint, or more simply, at the toe joint closer to the foot. The movements of this joint, like all other joints, are determined by muscles and tendons. When the toe is forced into a bent position for an extended period due to certain reasons, the tendons shorten, and over time, it can no longer straighten.
WHAT CAUSES HAMMERTOE DEFORMITIES?
- Improper footwear, especially shoes that are too narrow, too small, or not suitable for your foot arch.
- Flat feet. With flat feet, toes are more prone to deformities, especially if proper orthopedic insoles are not worn.
- Chronic joint diseases that affect all body joints, including those in the toes.
- Hallux valgus deformity. A severely inward-curving big toe pushes other toes into an improper position.
HOW IS THIS DEFORMITY DIAGNOSED?
We always perform a clinical evaluation of the foot. Most of these deformities are easily visible simply by looking at the toes. It is very important to assess joint movement, as with the progression of this deformity, the tendons can become so shortened that the toe remains bent and cannot be straightened without surgical treatment.
We also perform X-rays to assess the condition of the affected toe joints. We also evaluate for other foot deformities such as Hallux valgus or flat feet.
HOW TO AVOID HAMMERTOE DEFORMITIES?
Avoid narrow, small shoes. When choosing new shoes, it is important not just to try on your usual size, as shoe measurements can vary between different manufacturers. It is also very important to determine whether your foot is wide or narrow and choose shoes suited to your foot type. When trying on shoes, you should walk around, stand, and sit in them to understand if they are truly the right size, and do not pinch or rub.
HOW ARE THESE DEFORMITIES TREATED?
Conservative treatment measures are applied, which slow the progression of the deformity and can help restore the toe to its original position, but only for minor deformities.
1. Proper footwear.
2. Orthopedic insoles that distribute the load on the foot so that less pressure is placed on the toes.
3. Special orthopedic toe separators that should be worn daily in shoes.
4. Stretching exercises for foot muscles.
However, patients usually seek specialist help when the deformity has already significantly progressed, and the only effective way to correct the toe's position is surgery.
WHAT DOES HAMMERTOE DEFORMITY SURGERY LOOK LIKE?
If the toe is still flexible, tendon and ligament release or transfer may be performed. However, most often the joints are too damaged, the toe is no longer flexible, and joint fusion surgery (arthrodesis) must be performed.
During the operation, an approximately 2-centimeter incision is made on the dorsal side of the foot in the joint area. The joint surfaces and a portion of the bone are removed, and the toe is straightened and fixed in the correct position. For this, we usually use wires that are inserted through the tip of the toe into the phalanges. These wires need to remain in place for 3-6 weeks, after which they are removed. Typically, wire removal takes place during an outpatient consultation and does not require repeated surgery, as their ends are left exposed above the skin.
After deformity correction surgery, patients are usually discharged home on the same day. Patients are fitted with a special orthopedic brace, which allows them to walk on the operated foot by only putting weight on the heel.
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Karolina
