Hammer Toe

Definition 

 

Flexion deformity PIPJ with

- MTPJ normal / simple

- MTPJ hyper-extended / complex

- DIPJ any position

- P1 may become subluxed or dislocated

 

Aetiology

 

Uncertain

 

Long second toe / MT

Hallux valgus

Tight shoes

 

Examination

 

Hammer Toe Clinical Photo

 

Calluses

- dorsum of PIPJ

- beneath second MT head

 

Rigid v flexible

Correctable / Non correctable

 

Management

 

Non-operative

 

Extra depth or padded shoe, low heel

 

Operative

 

Concepts

- need to ensure enough room for corrected toe / shorten toe

- may need to treat HV as well

- may need to release flexor tendons if tight

 

1.  Flexible Deformity

 

Girdlestone-Taylor FETT

 

2.  Fixed PIPJ

 

A. DuVries Arthroplasty

 

B. Extensor tendon tenotomy + PIPJ fusion

 

C. Partial Proximal Phalangectomy

- leaves toe floppy

- poor cosmesis

- only as salvage

 

3.  Fixed PIPJ and Subluxed MTPJ

 

Extensor Tendon Tenotomy + PIPJ fusion

+ Dorsal MTPJ capsulotomy

+ MT osteotomy

 

PIPJ Fusion Weil OsteotomyPIPJ Fusion Weil Osteotomy Lateral