Hammer toes are a contracture of the toe at one or more of the toe joints. There are many causes of hammer toes, but typically a biomechanical abnormality that lead to a tendon imbalance is the primary cause. A contracture of the joint closest to the toenail is called a mallet toe. A hammer toe is a contracture of the second joint of the toe and is the most common digital deformity. A claw toe is a combination of a hammer toe and mallet toe. The metatarsal joint may be contracted with any of the above deformities. From a clinical and treatment standpoint, the most important factor is if the deformity is flexible or rigid.

Treatment options are really limited for hammer toes. If the deformity is flexible, you can treat the biomechanical abnormality that led to the deformity typically with a custom orthotic. If this is not a viable option, then a surgical procedure called a flexor tendon transfer is an excellent choice. This involves rerouting the long tendon on the bottom of the toe to the top of the toe. This changes this tendon from a deforming force to a corrective force. For a rigid deformity the options are surgical or live with the deformity (working around it with a wider, boxier shoe). Surgically the two choices are arthroplasty or arthrodesis. For completeness sakes, implant arthroplasty is also a possible treatment option for this deformity. I do not use implants for hammer toes unless there is a flail (floppy toe) deformity.

I have gone back and forth over my career between arthrodesis and arthroplasty, primarily because I have not been completely satisfied with either procedure. For mallet toes, arthroplasty is the primary choice. Hammer toes are much more common and will be discussed for the remainder of this blog. Arthrodesis provides a more predictable result, but often times the toe is too straight. Arthrodesis means fusion of the the two bones that make up the joint. Typically this is held in place with a pin that goes through the toe and is left in for six weeks. Arthroplasty just means removal of the end of the first bone. This is also held in place with a pin for three to six weeks. This procedure tends to provide a little more normal appearance to the toe, but the toe can shift once the pin is removed.

A newer modification arthrodesis procedure is the use of the Smart toe implant instead of a pin to hold the toe in alignment. The Smart toe has a straight and angled design. The straight design also makes the toe too straight in my opinion. I am a big fan of the angled design, which puts the toe in about a 10 degree downward position. This provides a more normal appearing toe and the toe tends to sit on the ground better. The implant stays in permanently and provides stability. The Smart toe is made by MMI and more information is available athttp://www.hammertoetreatment.com/mmi_smarttoe/index.html

If you have a hammer toe deformity, first have it evaluated by a podiatrist. Ask what your treatment options are. If you are having pain, corn formation, difficulty wearing shoes or redness; a surgical procedure may be the best option. Ask about the type of procedure being recommended. Ask why that procedure is being recommended. Ask if the doctor has any experience with the Smart toe implant. I hope this helps give you some guidance for you treatment of your hammer toe.

Patrick A. DeHeer, DPM