Hammertoe Deformity - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Human toes consist of several joints. Except for the big toe, each toe has three distinct joints, namely the metatarsophalangeal joint (MTP) situated at the base of the toe, the proximal interphalangeal joint (PIP) located in the middle of the toe, and the distal phalangeal joint (DP) located nearest to the toe tip. The big toe has two joints - the metatarsophalangeal joint and the interphalangeal joint.

What Is Hammertoe Deformity?

Hammertoe deformity, also known as hammertoe or rotated toe, is a common foot condition that affects the joints of the toes, particularly the proximal interphalangeal joint (middle joint). It is commonly seen in the second, third, and fourth toe. This deformity causes an abnormal bend in the joint, and it becomes fixed in a curled position. This deformity is more commonly found in women than men.

What Are the Types of Hammertoe Deformity?

There are three distinct types of hammertoes, namely:

• Flexible Hammertoes: At this stage, the hammertoe is in the developmental phase, and the toes involved can still move at the joint.

• Semi-rigid Hammertoes: The hammertoe is in the early stages of stiffening.

• Rigid Hammertoes: At this stage, the hammertoe has become inflexible due to the tightening of tendons and soft tissues, making it impossible for the toes to move.

What Are Other Variants of Hammer Toe?

Claw toes and mallet toes are other variants of hammertoes, indicating the specific joint where the toe's abnormal bending occurs. Mallet's toe causes abnormal bending of the joint near the toenail. A claw toe is abnormal bending of the toe like a claw. The difference between these two variants is that the claw toe involves the middle and end joints of the toe, whereas the mallet toe involves only the end joint.

What Are the Causes of Hammertoe Deformity?

Hammertoe deformity is caused by an imbalance of the muscles, tendons, and ligaments that support the toes. This imbalance can be caused by several factors, including:

• Genetics: Some people are genetically predisposed to developing hammertoe deformity. Since this condition is heritable, a person with a positive family history is more likely to develop hammertoe.

• Trauma: Trauma to the foot or toe can cause the muscles, tendons, and ligaments to become imbalanced, leading to the development of hammertoe deformity.

• Inappropriate Shoes: Wearing shoes that are too tight or too narrow can put pressure on the toes, causing this abnormal curling and bending. High heels also increase the chance of developing this deformity.

• Medical Conditions: Certain conditions, such as arthritis and diabetes, can increase the risk of developing hammertoe deformity.

Other risk factors for developing hammertoe deformity include:

• Aging.

• Gender (women are more likely to develop the condition than men).

• Foot structure abnormalities such as high arches or flat feet.

What Are the Symptoms of Hammertoe Deformity?

The primary indication of hammertoe deformity is the abnormal bending or curling of the toe at its middle joint, resulting in a hammer-shaped appearance. The other common symptoms of Hammertoe deformity include:

• Pain or discomfort in the affected toe, especially when wearing shoes or walking.

• Corns or calluses on the top of the affected toe.

• Swelling and inflammation of the affected toe.

• Restricted range of motion in the affected toe.

• Difficulty in walking.

• The affected toe may become rigid and unable to straighten out in severe cases.

How Can Hammertoe Deformity Be Diagnosed?

The diagnosis is based on a review of the patient's medical history, physical examination, and imaging tests. In physical examination, the doctor will examine the affected toe and assess its flexibility, range of motion, and overall appearance. They may also check for the presence of corns or calluses on the toe or the ball of the foot. Additionally, the doctor may examine the patient's footwear to determine whether it may contribute to the deformity's development.

Sometimes, the doctor may advise imaging tests, such as X-rays or MRI (magnetic resonance imaging), to evaluate the extent of the deformity and determine the best course of treatment.

A healthcare professional, such as a podiatrist or an orthopedic doctor, can diagnose hammertoe deformity.

What Is the Treatment for Hammertoe Deformity?

The treatment for hammertoe deformity varies depending on the severity of the condition and the patient’s level of discomfort or pain. Simple self-care measures can often relieve mild cases, while more severe cases may require surgical intervention.

Some common treatment options for hammertoe deformity include:

• Appropriate Footwear: Wearing shoes with a wide toe box and low heels can help reduce pressure on the affected toe and prevent the worsening of this condition.

• Padding and Taping: Non-medicated pads and tape can be used to relieve pain and pressure on the affected toe.

• Exercises and Stretches: Toe exercises and stretches can help improve flexibility and reduce pain.

• Medications: Pain relievers such as Ibuprofen and Acetaminophen can help relieve pain and inflammation.

• Orthotic Devices: Custom-made shoe inserts or orthotics can help redistribute pressure on the foot and relieve pain.

• Injections: Corticosteroid injections can reduce pain and inflammation in the affected toe.

• Surgery: It is performed to straighten the affected toe and relieve pain and discomfort in severe cases.

What Are the Surgical Methods for Hammertoe Deformity?

Surgery may be necessary in severe cases of hammertoe deformity where conservative treatments are ineffective, or the condition is causing intense pain or difficulty walking. Hammertoe surgery aims to straighten the affected toe and relieve pain.

Several surgical techniques are used to treat hammertoe deformity, which include:

• Arthroplasty: This technique involves removing a small section of bone from the affected toe to realign it. The toe joint is then stabilized using pins or screws while the bone heals.

• Arthrodesis: This technique involves fusing the affected toe joint to prevent it from bending. Pins or screws immobilize the affected toe and promote bone healing.

• Tendon Transfer: This involves taking a healthy tendon from another part of the foot and transferring it to the affected toe to straighten it.

• Joint Resection: This technique involves removing part of the affected toe joint to improve its alignment. All these techniques can help to straighten the toe and improve its function.

Hammertoe surgery is typically an outpatient procedure and can be performed under local or general anesthesia. Recovery time can vary depending on the severity of the condition and the type of surgical technique used. Patients may need to wear a special shoe or boot and avoid certain activities for several weeks to allow the toe to heal properly.

Conclusion:

Hammertoe deformity can be a painful and uncomfortable foot condition, making it difficult to wear shoes. The prognosis of hammertoe deformity depends on several factors, including the severity of the deformity, the underlying cause, and available treatment options. Mild deformity can often be managed with conservative methods. However, surgery may be required in severe cases where the hammertoe is rigid and causes pain, difficulty walking, and other complications. Early diagnosis and proper care provide significant relief from their symptoms and return to normal activities.