Hammer toe deformity

Abstract

Hammer toe deformity of the lesser toes is one of the most common surgically treated conditions of the foot and ankle. A hammer toe deformity consists of plantarflexion at the proximal interphalangeal (PIP) joint. In addition, the metatarsophalangeal joint (MTP) and the distal interphalangeal joint (DIP) are commonly extended. The etiology of a hammer toe deformity is often multifactorial and is associated with multiple medical conditions including hallux valgus, trauma, inflammatory arthritis, flexor digitorum longus contracture, and diabetes. Shoes with narrow toe boxes also play a role in the etiology of the deformity. Nonsurgical treatments for hammer toe deformity include activity and shoewear modification, cushioned toe sleeves, and taping of the toes. When nonsurgical treatments fail, surgical options for a fixed hammer toe include resection arthroplasty, arthrodesis, and amputation. The goal of surgical intervention is to achieve a pain-free, cosmetically appealing toe that accommodates normal shoewear without undue pressure. With proximal interphalangeal joint (PIP) arthroplasty or arthrodesis, options for fixation include Kirchner wire (K-wire) fixation and various intramedullary implants. Patient satisfaction and fusion rates of PIP arthrodesis are routinely documented to be greater than 90%.