Hammertoe deformity

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Most common deformity of the lesser toes.

A hammertoe deformity occurs when the second, third, or fourth toe bends at the middle joint, creating a hammer-like appearance.

Flexion deformity of the proximal interphalangeal joint of the toe, with hyperextension of the metatarsophlangeal and distal phalange joints.

In the early stage a flexible hammertoe is movable at the joints; a rigid hammertoe joint can’t be moved and usually requires surgery.

A hammertoe deformity can arise from a muscle imbalance, or by wearing ill-fitting shoes.

As the proximal interphalangeal (PIP) joint flexion progresses a compensatory hyperextension of the metatarsophlangeal (MTP) and the distal interphalangeal (DIP) occur.

Hyperextension of the MTP joint and flexion of the PIP joint make the PIP joint appear prominently on the dorsal surface.

Prominence of the PIP causes pain when it rubs against the shoe.

Initially the deformity is flexible, but becomes fixed over time.

Progressive deformity can lead to MTP joint dislocation.

Strongly associated with the presence of a second ray that is longer than the first, metatarsophalangeal synovitis and instability, inflammatory arthritis, neuromuscular abnormalities and poor fitting foot wear.

Metatarsophalangeal synovitis and instability are associated with a second ray that is longer than the first.

Hammer toe

It is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be bent, resembling a hammer.

In the early stage a flexible hammertoe is movable at the joints; a rigid hammertoe joint cannot be moved and usually requires surgery.

It most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot.

When the toes are bent for long periods of time causing the muscles in them to shorten, resulting in the hammer toe deformity.

Hammertoe is often found in conjunction with bunions or other foot problems.

Additional reasons for the cause of hammertoe
can be muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, Friedreich’s ataxia, complex regional pain syndrome or diabetes.

Conservative treatment with physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition in many patients.

Exercises can be done to stretch and strengthen the muscles.

In severe or longstanding cases surgery may be necessary to correct the deformity.

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