Hammer Toe Deformity

As the condition advances and becomes more long-standing, the affected joints become stiff and require more extensive operative procedures to address them.

There can be a rotational component to the deformity, causing the affected digit to override the adjacent toe.

A hammer toe is frequently associated with a corn or callus on the top of the middle joint of the toe or on the tip of the toe. There is often metatarsalgia, pain under the relevant metatarsal head.

A hammer toe can result from ill-fitting shoes or a muscle imbalance, but usually in combination with one or more other factors. There is invariably degenerative change affecting the plantar plate, the specialised, stabilising fibro-cartilaginous structure beneath the joint at the base of the toe. As this ligament-like tissue deteriorates, it elongates and tears, allowing the joint to deform and become unstable. This contributes to the development of metatarsalgia, pain under the metatarsal head. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position for long enough, the muscles and tendons contract, maintaining the deformity.

Narrow, close-fitting shoes crowd the lesser toes, moulding them and contributing to the development of fixed deformity. High-heeled footwear exacerbates the problem.

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be longer than the longest toe. This is frequently the second digit. Tight, narrow, high-heeled shoes should be avoided. Shoes with a deep toe-box can accommodate the hammer toe, or a shoe repair shop may be able to stretch the toe-box so that it bulges around the deformity.

A podiatrist can help with commercially-available straps, cushions or non-medicated corn pads to relieve symptoms. An orthotist can manufacture an offloading insole, incorporating a metatarsal dome. This shifts weight-bearing stress away from a tender prominent metatarsal head.

A hammer toe can be corrected surgically if non-operative measures fail to control symptoms. The actual procedure will depend on the type and extent of the deformity, but it often involves the use of a buried wire (pin) or screw. A post-operative shoe is typically worn for a few weeks and it can take as long as 3 months for all post-operative swelling to resolve.