hammertoes

Most hammertoes are caused by an imbalance in the pull of the extensor and flexor tendons to the toe, resulting in a deformity wherein there is generally dorsiflexion of the proximal phalanx and plantarflexion of the middle and distal phalanx. In its earlier stages, the deformity can generally be manually reduced, and at this stage correction can generally be accomplished by soft tissue surgery with release of the interphalangel ligaments and sometimes tenotomies. As the deformity progresses, the head of the proximal phalanx frequently over-rides the middle phalanx, causing the joint to physically lock and creating a situation wherein the deformity is no longer reducible manually. At this stage, typical treatment involves bone surgery wherein the head of the plantar phalanx is resected and the toe straightened. Sometimes a fusion of the joint is performed, but, in my opinion, that should not be done unless really necessary to maintain correction.

Certain diseases and condition such as rheumatoid arthritis, cavus foot and some neuromuscular conditions, spinal condition and brain abnormalities can also result in hammertoes.

The main problem resulting from hammertoes is pain from the toe box of the shoe rubbing on the apex of the deformity, generally creating a corn, but sometimes an ulceration. At least the symptoms of hammertoes can sometimes be adequately addressed by shoe selection or padding when possible. This may avoid surgery if symptoms are the only complaint, but is not truly corrective.