Hammertoe/mallet toe - Cause and treatment - Surgery

What is a hammer toe?

It is when the little toes (second to fifth toes) display a contracture in one of more joints. This abnormal curvature puts pressure on the toe when wearing shoes, which leads to problems.

Causes of hammer toe

The cause is generally found in an imbalance of muscle and tendon contractions. This imbalance is usually the result of mechanical changes to the foot as we age. This is naturally exacerbated by wearing ill-fitting shoes. In rare cases a hammer toe may be caused by trauma. In some cases hammer toes are congenital.

Hammer toe complaints

Pain in or irritation of the toe. Painful callus formation in several places is possible, which may be hard or soft, depending on the location. Pain in the underside of the foot as a result of dislocation of the toe at the base.

Treatment for hammer toe

There are both surgical and non-surgical options for tackling this problem:

Non-surgical: A number of non-surgical treatments may be proposed:

• Removing the calluses. This is best carried out by a professional pedicurist or chiropodist.
• Covering the calluses. This is also best carried out by a professional pedicurist or chiropodist.
• Wearing a shoe insert. This will be particularly helpful if the hammer toe is still flexible.
• Adjusting your footwear; avoiding shoes that are too narrow and wearing ones with sufficient room for the little toes.

Surgical: In cases where the hammer toe has become rigid, surgery is the best option to alleviate the pain and discomfort.

The different treatment options are:

• A small section of the bone of the affected joint is removed, with the aim of correcting the position. A second option is to perform an arthrodesis. This involves immobilising the affected joint in a certain position, into which it grows. This is usually achieved through pin fixation, for a period of circa five weeks.
• Corrective osteotomy of the toe: Usually in the case of dislocation of the MTP joint (Weil osteotomy).
• Soft tissue surgery: Usually extensor extension or flexor tendon transfers.

The type of surgery required in your particular case is discussed during the preceding consultation. The number of toes affected, severity of the defect, the cause and age of the patient are taken into account.

This content was written by : Dr. Stijn Muermans, Dr. Mark van Dijk, Dr. Jan Van Oost