HAMMER TOE - DIGITUS MALLEUS
When the toe stays bent
The hammer toe is a common toe deformity in which the PIP joint (the proximal interphalangeal joint) of the second to fourth toe is fixed in a bent position. At the same time the joint at the base of the toe (the MTP joint) is often overextended, which gives the characteristic hammer-like appearance.
As it progresses the deformity can become rigid, meaning it can no longer be straightened passively. Left untreated it frequently leads to secondary problems such as calluses, painful pressure points or difficulty with footwear.
How does a hammer toe arise?
A hammer toe usually arises from several factors acting together. Mechanical overloading as well as anatomical or genetic causes can disturb the balance of the toe muscles and lead to a permanent deformity.
- An imbalance between the flexor and extensor tendons pulls the toe out of position
- Degenerative changes or changes after an injury damage the mechanics of the joint
- A family predisposition makes a hammer toe more likely
- Narrow or pointed shoes put chronic pressure on the toes
- Deformities such as hallux valgus or a splayed forefoot shift the load onto the lesser toes
Symptoms
The symptoms of a hammer toe usually develop gradually and affect above all the middle joint of the toe. Depending on how pronounced it is, the deformity can lead to painful pressure points and to functional restrictions – particularly when wearing shoes
Pressure pain
Localised pressure pain over the upper aspect of the PIP joint
Clavus (a corn)
Formation of a clavus (a corn) or of calluses where the shoe rubs
Restricted movement
The affected toe can be straightened actively only to a limited extent, or not at all.
Treatment of a hammer toe
Treatment depends above all on whether the deformity is still mobile or already fixed. As long as the toe can be straightened passively, measures that take the pressure off come first: suitable footwear, padding, insoles and exercises for the small muscles of the foot.
Where the deformity is rigid, or where it causes persistently painful pressure points, a procedure corrects the position of the toe – depending on the findings at the tendons, at the toe joint or at the metatarsal bone. The aim is to remove the pressure points and to make the roll-off even again.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Footwear that suits the foot
Shoes with a wide toe box, a flat sole and a soft upper reduce the pressure on the bent joint.
Padding and pressure protection:
Soft ring pads, silicone sleeves or corn plasters take the load off irritated areas of skin and prevent pressure points.
Individually made insoles
Where there is also a splayed forefoot or a hallux valgus, orthopaedic insoles help to improve how pressure is distributed across the forefoot and to stabilise the biomechanics.
Physiotherapy
Targeted exercises strengthen the small muscles of the foot (the lumbricals and interossei, for instance) and improve the motor control of the toes.
Tendon transfer or lengthening
Where the deformity is still partly flexible, the long flexor tendon (flexor digitorum longus) can be transferred to the upper side of the toe or lengthened. The aim is to even out the muscular imbalance and straighten the toe.
Hohmann arthroplasty
With a rigid hammer toe, part of the PIP joint (as a rule the head of the proximal phalanx) is removed, so that the joint can straighten again. The toe usually stays mobile; a temporary wire is often inserted to stabilise it.
Weil osteotomy
This method is used where the deformity is more pronounced or where the head of the bone carries additional load. It corrects the length and the axis of the bone and can treat pain under the forefoot (metatarsalgia) at the same time.
Fusion of the PIP joint
Where the deformity is severe or there is secondary osteoarthritis, the middle joint of the toe is fused in a functional position. The joint surfaces are removed and fixed stably with a wire, a screw or an implant. The aim is a pain-free, corrected toe axis.
Combined correction of the forefoot
A hammer toe frequently occurs together with a hallux valgus or a splayed forefoot. In such cases the operation is embedded in an overall treatment plan, in order to correct the whole mechanics of the foot and to avoid a recurrence.
Common questions about the hammer toe
How do I recognise a hammer toe?
Can a hammer toe correct itself?
Are high or narrow shoes to blame?
Does every hammer toe have to be operated on?
How long does healing take after the operation?
Our foot specialists
Experienced specialists for the hammer toe and foot surgery
