- There are 5 phalanges, commonly referred to as toes, that connect with the long metatarsal bones that make up the forefoot.
- The toes are made up of 3 joints: distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, and metatarsophalangeal (MTP) joint.
What are Hammertoes?
- Hammertoes are created when the PIP joint is flexed, the DIP joint is extended, and the MTP joint is either neutral or extended.
- The toe deformity points upward and then the end of the toe downward, appearing like a hammer.
- Early deformities are typically less rigid whereas progressive hammertoes are rigid from tightness of the tendons and require surgical correction.
How Do Hammertoes Happen?
Research shows hammertoes are more common in elderly women.
- Primary Effects
- Bunion deformity, causing second hammertoe
- Excessive tightness of extensor digitorum longus
- Long second toe
- Secondary effects that can lead to hammertoe
- Rheumatoid arthritis
- Diabetics with peripheral neuropathy
- Inflammatory joint disease
- Connective tissue disorders
- Unequal muscle firing patterns of foot intrinsic musculature
- Abnormal gait mechanics caused by sprain, strain, or fracture
- Forefoot and midfoot instability
- Poorly fitted shoes (most common cause – narrow shoe box, high heeled shoes)
- Pain on the top side of the toe where it makes contact with the upper part of the shoe
- Callus formation on the tip of the affected toe near the toenail
- Corn formation on the middle toe joint (PIP)
- Pain in the ball of the foot
Articles Related to Hammertoes
- Ran, H., Palisch, A., & Ahuero, J. (2017). Utilization of Retrofusion screw for PIP fusion for treatment of hammertoes. Foot & Ankle Orthopaedics. https://doi.org/10.1177/2473011417S000335
- Malhotra, Karan et al. “The pathology and management of lesser toe deformities” EFORT open reviews vol. 1,11 409-419. 30 Nov. 2016, doi:10.1302/2058-5241.1.160017