What Can I Expect from Hammer Toe Surgery?

Hammer-shaped toe is the most common toe deformity in the clinic. It refers to the extension of the metatarsophalangeal joint and the distal interphalangeal joint and the proximal interphalangeal joint flexion, which results in a mid-toe flexion deformity.

Basic Information

Visiting department

orthopedics

Common locations

Toes

Common causes

Caused by trauma, neuromuscular disease, degenerative changes, or congenital causes, but most may be caused by inappropriate footwear

Common symptoms

Flexion deformity with or without pain

Causes of hammer toe, mallet toe, claw toe

The toe deformities mentioned above may exist alone or be related to other forefoot diseases. Although some toe deformities are caused by trauma, neuromuscular disease, degenerative changes, or congenital causes, most may be caused by inappropriate footwear. The typical hammer toe is caused by direct compression of shoes that are too tight or too small. The main basis for judging a soft or stiff deformity is whether it can be passively corrected to a neutral position; mallet toes can be caused by damage to the distal interphalangeal joint or toe extension device, but over-tight shoes are also an important factor; claw-shaped toes Deformation is considered to be an endogenous deformity caused by weakness or loss of function in the internal muscles of the foot. Too tight shoes may cause claw-shaped toe deformities, but the intrinsic muscle strength of the foot is weakened, resulting in the internal and external muscles of the foot. Caused by imbalance. Occasionally in patients with bilateral onset, claw-shaped toes are secondary to neurological disease (with arcuate feet) or inflammatory joint disease, such as rheumatoid arthritis.

The toe deformity can be divided into softness and stiffness. Softness is a deformable that can be passively corrected, and the formation time of deformity is generally short; rigid deformity is a deformity that cannot be passively corrected, and the formation time of deformity is generally long.

Clinical manifestations of hammer toe, mallet toe, claw toe

The affected toes are mainly manifested as different types of flexion deformities, with or without pain. The exact location of the pain may be difficult to determine, but typical pain is often limited to the forefoot. Occasionally, if symptoms are limited to the dorsal side of the affected toe, it is easy to locate. Hammer toe or claw toe may hit an over-tight toe. Pain often resolves when the patient is barefoot. Similarly, the symptoms of mallet toe usually only appear at the tip of the toe. With synovitis and weakened metatarsophalangeal joint function, patients often complain that the pain is located on the plantar bottom of the forefoot, but the exact location cannot be determined. The deformity caused by the impact or the increase in pressure between the toes can also cause the toes, the back of the toes, or the palate or corns to form.

Hammer toe, mallet toe, claw toe inspection

The diagnosis may be easy, but not only the affected toes but also the forefoot should be thoroughly and thoroughly checked to prevent the misdiagnosis of other combined forefoot diseases. For example, an over-tight rear upper can cause excessive load on the forefoot, which should be dealt with while correcting toe deformities. Similarly, the relatively obvious claw-shaped toe deformity may be associated with hallux valgus. For example, treating the affected toe alone but not the hallux deformity will lead to the early recurrence of the toe deformity. Clinical examination should record whether the deformity is soft or rigid, which has guiding significance for surgical treatment. Also check the feet, hind feet, and ankles in the patient's standing position. Ankle or sacroiliac joints (distal boat and heel roll joints) have limited active or passive dorsiflexion, and / or high arched foot deformities can lead to excessive weight bearing or deformity of the forefoot. Restricted active or passive eversion of the hindfoot, or hindfoot inversion can lead to excessive weight bearing on the outside of the forefoot.

Image examination: The standard weight-bearing plain radiographs of the foot (positive, lateral, and oblique) can not only meet the needs of assessing toe deformity, but also check the hind and midfoot at the same time to determine that there is no forefoot Deformity. With the continuous development of MRI technology, it can provide details of forefoot joint capsule tissue, ligaments and even toe nerves.

Hammer toe, mallet toe, claw toe treatment

Non-surgical treatment

Non-surgical methods can alleviate many symptoms caused by toe deformities. Changing shoes, using orthotics, or simple pads and spacers can not correct the deformity, but it can reduce the pressure. Increasing the depth of the toe can reduce the pressure on the dorsal side of the hammer toe, mallet, and claw toe. Wide toe shoes can reduce lateral pressure, especially when accompanied by hallux valgus or small toe bursitis, it can also relieve the pressure between the toes. Placing spacers, silicone covers and cashmere pads between the toes can limit the formation of corns caused by excessive pressure between the toes. For soft hammer-toe or claw-shaped toe deformities, a hammer-toe sling or tape may be beneficial, but it does not solve the problem permanently. For mallet toe deformities, pressure can be transferred to the proximal or middle phalanges by using a toe cuff to reduce the load on the distal phalanges. For those who have deformed foot pain, the use of hard-soled shoes with mild rocker-like soles can reduce the pressure on the metatarsal head and the stress on the metatarsal plate during the gait phase.

Non-surgical treatments are effective in relieving acute symptoms and stress, but conservative measures cannot correct the deformity. Patients with deformities, especially stiff deformities, may require surgery.

2. Surgical treatment

For deformities that have failed conservative treatment, surgical treatment is available to correct the deformities. However, after the orthopedic toe, a certain degree of stiffness or deformity of the metatarsophalangeal joint or the proximal interphalangeal joint may appear.

(1) Soft hammer toes can usually be corrected by flexor-extensor tendon transposition. Stiff hammer-shaped fingers should undergo joint capsule and lateral collateral ligament release and arthroplasty or interphalangeal joint fusion.

(2) Soft mallet toes can be treated by percutaneous toe long flexor release. For stiff mallets, resection arthroplasty or interphalangeal joint fusion is usually effective.

(3) Soft claw-shaped toe The correction is similar to soft hammer-shaped toe. However, the soft tissue release of the metatarsophalangeal joint is more demanding. Percutaneous toe flexor tendon elongation is sometimes required to correct flexion deformity of the interphalangeal joint. The treatment of stiff claw-shaped toes is similar to that of stiff hammer-shaped toes, but the soft tissue release of metatarsophalangeal joints and shortening of metatarsal bones are more demanding than stiff hammer-shaped toes.

Hammer toe, mallet toe, claw toe prevention

Avoid wearing tight or too small shoes. For patients with hallux valgus, special attention should be paid to avoid wearing high heels and shoes with a narrow front to prevent other toe deformities. For patients with congenital toe deformity, appropriate protective gear can be applied while adjusting the shoes to prevent the deformity from further aggravating.