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 second toe greater than 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

• Usually affects second, third, or fourth toe
• 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

In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while 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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