Hammer Toes

Question 1

What is this?

Answer 1

Hammer toe

Question 2

Whis toes are affected by hammer toe

Answer 2

Lesser toes - most commonly the second toe

May be associated with hallux valgus

Question 3

What joints are affected in hammer toe

Answer 3

Flexion deformity at the PIP joint

The DIP joint can be in any position, but extension is most common

Neutral of extension at the MTP joint

*Hammer toe deformities are primarily confined to the interphalangeal joints

Question 4

How would you complete the examination of a patient with hammer toe

Answer 4

Watch the patient walk

Examine her shoes

Assess the effect on her life

Question 5

What is the cause of hammer toes

Answer 5

Imbalance between intrinsic and extrinsic muscles of the lesser toes

Question 6

Who is likely to get hammer toes

Answer 6

Females more than males

Elderly

Patients with RA

Question 7

How would you treat hammer toes

Answer 7

Non-surgical:-

• Appropriate footwear

Surgical:-

• Mobile deformity
  
  • Flexor-to-extensor tendon transfer
• Fixed deformity
  
  • Resection of the proximal phalangeal head and neck with possible flexor and extensor release
  • Proximal phalangectomy
  • PIP joint arthrodesis
• Painful callosities
  
  • Consider terminal phalangectomy

Question 8

What is the appropriate footwear for hammer toes

Answer 8

High

Wide toeboxes

Semirigid longitudinal arch supports with metatarsal pads to evenly distribute plantar pressure