Hammer toes and claw toes are common toe deformities characterised by abnormal bending or curling of the smaller toes, excluding the big toe.
In hammer toes, the affected toe bends downward at the middle joint, resembling a hammer. Claw toes, on the other hand, involve a bend at both the middle joint and the joint closest to the tip of the toe, giving the toe a claw-like appearance.
Corns, calluses, and ulcers may develop over the affected joints, further exacerbating symptoms. Additionally, the altered biomechanics of the foot can affect gait and balance, leading to potential complications such as difficulty walking or maintaining stability.
Overall, hammer and claw toes can significantly impact one’s quality of life, necessitating appropriate management and treatment to alleviate symptoms and prevent further complications.
In hammer toes, the affected toe bends downward at the middle joint, known as the proximal interphalangeal (PIP) joint, resembling the shape of a hammer. This downward bending can lead to the formation of a prominent knuckle or bump at the top of the toe. Hammer toes are often more flexible than claw toes, meaning they can still be straightened to some extent manually.
Claw toes involve a bend at both the PIP joint and the joint closest to the tip of the toe, known as the distal interphalangeal (DIP) joint. This results in the toe appearing claw-like, with the tip of the toe pointing downward while the middle joint is also bent upward. Claw toes tend to be more rigid than hammer toes, with limited ability to straighten the affected joints manually.
The development of hammer and claw toes can be attributed to various factors:
Symptoms of hammer and claw toes include:
The anatomy of the foot plays a crucial role in the development of hammer and claw toes. Several structures contribute to the stability and alignment of the toes.
The anatomy of the foot is intricately involved in the development of hammer and claw toes. Several key structures contribute to the alignment and stability of the toes:
Metatarsal bones: These elongated bones form the framework of the forefoot, providing essential support during weight-bearing activities. Variations in metatarsal bone length or prominence may predispose individuals to toe deformities such as hammer or claw toes.
Toe joints: The toes are composed of multiple joints, including the metatarsophalangeal (MTP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints. These joints allow for flexibility and movement. Dysfunction in the ligaments and tendons surrounding these joints can result in abnormal toe positioning and deformities.
Ligaments and tendons: Ligaments are strong fibrous bands that connect bones to each other, providing stability to the joints. Tendons connect muscles to bones, facilitating movement. The plantar plate ligament, situated beneath the toes, plays a crucial role in maintaining toe stability. Damage or laxity in these structures can contribute to the development of toe deformities.
Muscles: The foot houses both intrinsic and extrinsic muscles responsible for toe movement and alignment. Intrinsic muscles are located within the foot, while extrinsic muscles originate from the leg and control foot and toe movements. Imbalances or weaknesses in these muscles can lead to abnormal toe positioning and deformities.
Non-operative management is the initial approach, focusing on alleviating symptoms and correcting the deformity through conservative measures:
If non-surgical methods fail to provide relief, surgical intervention may be necessary.
Surgery can involve a number of small procedures on the toe depending on the degree of deformity and the exact problem.
Usually the bent knuckle in the middle of the toe (the PIP joint) will need to be straightened and possibly fused. This may require a pin in the toe which is left just 5mm out of the toe. This will then be removed after 4-6 weeks. Removal of the pin is straight forward. It takes just a few seconds and is no more painful than having stitches removed. No anaesthetic is required. Sometimes an internal pin or dissolvable pin can be used without the need for an external pin.
Additional adjustments, such as tendon lengthening or metatarsal head shortening (knuckle bone at bottom of toe joint), may also be performed to correct the deformity.
Surgery is generally performed as day surgery unless combined with bunion or other surgery, which may require an overnight stay.
Following surgery, patients are advised to limit weight-bearing activities and elevate the foot to reduce swelling. A post-operative sandal or cast may be worn for support during the initial recovery period.
Full recovery from toe surgery typically takes several weeks to months, during which patients may experience swelling, stiffness, and discomfort. Physical therapy and rehabilitation exercises may be recommended to restore strength and mobility to the toes, however some stiffness of the toe is common as the toe cannot be made perfect again once the previous damage has already occurred.
These notes from OrthoSport Victoria are for educational purposes only and are not to be used as medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.
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