Hammer Toe

toe deformity bunion hammer
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A hammer toe deformity occurs when the PIP joint is abnormally bent. This most often occurs in the second toe, and is often the result of a big toe bunion pushing on the second toe. A painful callous often forms on top of the first joint in the toe.

The PIP joint is one of three joint in each of the lesser toes (the four toes other than the big toe).  The MTP joint is at the base of the toe, then the PIP joint, and the DIP joint is at the tip of the toe.

  The PIP joint is abnormally bent, causing the top of this joint to be prominent in a hammer toe deformity.

In the photo on this page, the big toe has a bunion deformity, and the second toe has a hammer toe deformity.  Patients with a hammer toe often have a callous form directly on top of the PIP joint.  This combination of a bunion of the big toe and a second hammer toe deformity is extremely common.  The bunion deformity causes the hammer toe to form as a result of pressure forcing the abnormal position of the second toe.

Hammer Toe Treatment

Treatment of a hammer toe should usually consist of simple steps to start.  While more invasive treatments may become necessary, non-invasive treatments should be attempted first.  Initial steps of treatment should consist of simple padding of the callous on top of the toe, as well as buying appropriate footwear. The best shoes for patients with a hammer toe will have a wide toe box, no pressure on the end of the toe, and will not press on a bunion (which may cause worsening of the hammer toe).

Special inserts can be used to help alleviate pain from a hammer toe including doughnut cushions and gel sleeves.  These inserts will alleviate pressure on the callus that has formed.

If these treatments are not sufficient at correcting the hammer toe, an operation to straighten the toe may be necessary.

This is often performed in conjunction with surgery for a bunion deformity. The surgical treatment of a hammer toe can consist of either cutting the tendons to relieve the pressure that causes the deformity, or fusing the toe so that it points straight permanently.  Usually the surgery depends on if the hammer toe deformity is flexible (can be straightened) or fixed (is stuck in the abnormal position).

Results of surgical treatment are typically good, so long as the deformity is adequately addressed, including associated deformities of other toes (such as bunions).  Possible complications of surgery include infections, persistent pain, and recurrence of the deformity.

Sources:

Mizel, MS, Yodlowski ML; "Disorders of the Lesser Metatarsophalangeal Joints." J. Am. Acad. Ortho. Surg., May 1995; 3: 166 - 173.

Shirzad K, et al. "Lesser Toe Deformities"J Am Acad Orthop Surg August 2011; 19:505-514.

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