To properly evaluate hammertoes, it is beneficial to retrieve diagnostic imaging. If palpating the articular portions of the metatarsal head reveals an increase in tenderness and instability, it may require a different treatment than if the patient presented with an isolated hammertoe deformity. Attempting passive correction at the IPJ is important since it will assist in determining the treatment options. The MTPJ should undergo a range of motion and quality assessments as well. The physical examination should also include neurovascular evaluation, including palpation of pulses.įlexible hammertoes are generally present upon weight-bearing and are corrected when the ankle is passively placed in a neutral position, whereas the rigid deformity is not. A Lachman test should be performed to evaluate the MTPJ instability along with recordings of the flexibility of all deformities. Therefore, the evaluation and assessment of the pathology are often divided into weight-bearing and non-weight-bearing exams. It is important to evaluate the patient's feet in standing as well as in a sitting position as many deformities cannot be correctly appreciated solely during the seated examinations. ĭuring the physical examination, the trained examiner should evaluate the biomechanics of the patient's feet to look for possible causes of the hammertoe deformity and for accompanying deformities such as hallux valgus. Patients will occasionally complain of pain to the plantar aspect of the head of the metatarsal, and this usually occurs when the MTPJ is hyperextended, subluxated, or dislocated.
#HAMMER TOE SKIN#
By evaluating the skin, there may be blisters, callosities, ulcerations, and irritated skin dorsally over the PIPJ, plantar to the head of the metatarsals, and/or at the distal tip of the toe which is formed from the increased pressure to these areas. As the deformity progresses, the severity of symptoms gradually increases. Patients typically present with chronic pain that is exacerbated by ambulation and shoewear. It is not uncommon that the affected toe will become red and painful. The hammertoe is commonly described as a chronic progressive deformity with flexion noted to the proximal interphalangeal joint of the affected digit. Any imbalance in these forces will favor the stronger extrinsic muscles and thus will result in an extended proximal phalanx and possible MTPJ hyperextension, as well as with a PIPJ and/or DIPJ flexion due to the long unopposed flexor. A proper clinical evaluation of the patient is, therefore, of the utmost importance when aiming for long-term reduction of the deformity.ĭeformities of the lesser digits result from an imbalance between the weak intrinsic muscles and the stronger extrinsic muscles. If conservative management fails and pain persists with worsening deformity, the patient may benefit from surgical intervention. There are different types of characteristics of the deformities, and depending on its rigidity, the surgical approach will differ. Treatments should first and foremost be centered around conservative measures such as wearing shoes with a wider toe box, toe pads, and the proper utilization of orthotics. It is, therefore, important to know that there is a multitude of viable treatment options to consider. Hammertoe is a deformity that involves flexion at the interphalangeal joints (IPJ) and can be distinguished into categories including the classic hammertoe, mallet toe or claw toe. With the lesser digits being an important component in the balance of the foot, as well as in pressure distribution, deformities may lead to compensatory gait changes, distortions in cosmetics, callous formations, and pain. It results from an imbalance between the weak intrinsic muscles and the stronger extrinsic muscles surrounding the metatarsophalangeal joints (MTPJ) of the lesser digits.
Hammertoes are among the most common deformities of the forefoot.
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