Hammer toe

Hammer toe
A Mallet Toe is evident on the 3rd digit
ICD-10	M20.4, Q66.8
ICD-9	735.4, 755.66
MeSH	D037801

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Mohsin, M.D.[2], Cafer Zorkun, M.D., Ph.D. [3]

Synonyms and keywords: Claw toe; hammertoe syndrome; mallet toe

Overview

A hammer toe is a deformity of the second, third, or fourth toe causing it to be permanently bent at the proximal interphalangeal joint, resembling a hammer. Mallet toe is another name for this condition when affecting the distal interphalangeal joint.

Pathophysiology

• Hammer toe occurs due to abnormal (permanent) bend at the proximal interphalangeal joint of a toe due to imbalance in the muscles, ligaments, or tendons which normally hold the toe in a straight position

Risk factors

Common risk factors include:

• Advancing age
• Female sex
• Length of the second toe greater than the big toe
• Osteoarthritis
• Rheumatoid arthritis
• Diabetes

Complications

Few complications of hammer toe include:

• Permanent bent of the toe if not treated initially when toe is flexible
• Painful corns or calluses due to rubbing of toes against the inside of foot

Causes

Common causes of muscle, nerve, or joint damage resulting in a hammer toe include:

• Wearing poorly-fit shoes that can force the toe against their tip, such as:
  • Excessively high heels
  • Shoes that are too short or narrow for the foot
  • Osteoarthritis
  • Rheumatoid arthritis
  • Stroke
  • Charcot-Marie-Tooth disease
  • Diabetes

History and symptoms

• Hammer toe usually involves the second, third, or fourth toe
• Common symptoms include:
  • Abnormal bend in the joint of one or more toes resembling a hammer
  • Painful or difficult movement of the affected toe
  • Painful calluses & corns may form (due to rubbing of hammer toes against the inside of the shoes)

Treatment

Conservative treatment

• In many cases, conservative treatment is enough to resolve the condition such as:
  • Physical therapy
  • New shoes with soft, spacious toe boxes

Surgery

• In more severe or longstanding cases, orthopedic surgery may be necessary to correct the deformity

Prevention

Primary preventive measures for hammer toe include:

• Buying the shoes with following characteristics:
  • Proper fitting
  • Low heels
  • Adequate toe room (avoiding shoes with pointed toes)
  • More roomier and adjustable (laced or strapped shoes)

References

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