Hammer Toe and Mallet Toe

  What is a hammer toe?

A hammer toe is a deformity affecting one of the smaller toes. The middle joint bends upwards, with the end of the toe often bending downwards.

A hammer toe can initially remain flexible but may become stiff and fixed over time.

What symptoms and signs might I experience?

• A bent or curled toe.
• Pain from rubbing against shoes.
• Corns or calluses over the prominent joint.
• Pain underneath the toe or forefoot.
• Difficulty fitting the toe into shoes.
• Increasing stiffness.
• In severe cases, the toe may sit underneath or over another toe.

How is it diagnosed?

Diagnosis is usually made through examination. X-rays may be taken to assess the position of the bones and joints, particularly if surgery is being considered.

How is it treated without surgery?

Treatment may include:

• Wider and deeper footwear.
• Toe pads or sleeves.
• Insoles to redistribute pressure.
• Treatment of corns and calluses.
• Exercises and stretching if the toe remains flexible.
• Treatment of associated bunions or forefoot problems.

When might surgery be considered?

Surgery may be considered if the deformity remains painful despite appropriate treatment or makes footwear and normal activities difficult.

What might surgery involve?

For a flexible deformity, surgery may involve releasing or balancing the tendons.

For a stiff deformity, surgery may involve:

• PIP joint arthroplasty.
• PIP joint fusion.
• Tendon release or lengthening.
• Correction of an associated metatarsal problem.

What is recovery like?

You will usually be able to walk in a protective postoperative shoe. The toe can remain swollen and stiff for several weeks or months. The smooth wire is removed at 6 weeks.

The final position of the toe can take time to settle.

Mallet Toe

What is a mallet toe?

A mallet toe is a deformity affecting the end joint of a toe. The end of the toe bends downwards.

What symptoms and signs might I experience?

• Pain at the tip of the toe.
• Rubbing against shoes.
• Corn or callus formation.
• Difficulty finding comfortable footwear.
• Changes to the toenail from repeated pressure.
• A visibly bent toe.
• Toe tip ulceration

How is it diagnosed?

Diagnosis is usually made clinically. X-rays may be used to assess the underlying bones and joints.

How is it treated without surgery?

Treatment may include:

• Wider footwear.
• Soft toe sleeves or pads.
• Insoles.
• Treatment of corns and calluses.
• Stretching where appropriate.
• Activity modification.

When might surgery be considered?

Surgery may be considered if the deformity remains painful and interferes with footwear or daily activities.

What might surgery involve?

Depending on the flexibility of the deformity, surgery may include:

• Tendon release.
• Tendon lengthening.
• Joint correction.
• Fusion of the affected joint.
• Removal of part of the bone in selected cases.

What is recovery like?

Most patients can walk in a protective shoe following surgery. Swelling can remain for several weeks or months. A smooth wire is removed at 6 weeks.