Hammer toe deformity is the most common deformity of the lesser toes.

The fundamental problem is a chronic imbalance between flexion and extension force of the lesser toes from intrinsic forces, extrinsic forces, or both.

With progressive proximal interphalangeal (PIP) joint flexion deformity, compensatory hyperextension of the metatarsophalangeal (MTP) and distal interphalangeal (DIP) joints typically occurs.

The hyperextension of the MTP joint and the flexion of the PIP joint make the PIP joint prominent dorsally. This prominence rubs against the patient's shoe, causing pain.

At early stages, the deformity is flexible and passively correctable, but with time, it typically becomes fixed. Progressive deformity can lead to MTP joint dislocation.

CAUSES

Causes of hammer toe deformity include the following

  • A foot in which the second ray is longer than the first
  • MTP synovitis and instability
  • Inflammatory arthropathies
  • Neuromuscular conditions
  • Ill-fitting shoe wear

TREATMENT

Conservative treatment includes strapping of the toe with either tape or a commercially available hammertoe sling. This approach is helpful for a flexible deformity; however, it mandates the use of shoes that will accommodate the straps or slings.

Surgical treatment of hammertoe deformity has historically been based on altering the relative lengths of the toe and its tendons in order to achieve balance between extensor and flexor forces.

Options have included the following

  • PIP joint resection arthroplasty
  • PIP joint fusion
  • Tendon transfers
  • Tendon lengthening
  • Metatarsal shortening

Metatarsal shortening has gained renewed interest, but PIP joint resection arthroplasty and tendon transfers are the main procedures we use for hammertoe correction.

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