Hammer & Claw Toes

Lesser toe deformities are one of the most common forefoot complaints. Sometimes lesser toe problems are erroneously considered minor, when in fact they can have a significant impact on a patient’s life.

The causes of hammer and claw toes include plantar plate rupture, intrinsic muscle imbalance, neuromuscular conditions including diabetes and lumbar disc disease, hallux valgus (bunions), overcrowding in a tight shoe’s toebox, excessively long metatarsal bones, sequelae of trauma, congenital deformities, and inflammatory arthropathies like rheumatoid arthritis.

A hammer toe occurs when there is flexion of the first toe joint (proximal interphalangeal [PIP] joint), with or without flexion of the end toe joint (distal interphalangeal [DIP] joint). Claw toes are when there is extension where the balls of the foot meet the toes (metatarsophalangeal [MTP] joint] along with flexion of the PIP and DIP joints.

Toes are important for pressure distribution and balance. Deformities lead to pain, callous/corn formation, transfer lesions, and compensatory gait changes.

Conservative treatment for hammer and claw toes includes wearing shoes with wide deep toe boxes, splinting with devices such as a Boudin splint, taping toes to hold them in position, and anti-inflammatory medications for pain relief.

Surgery for hammer and claw toes depends on the cause and severity of the deformity, and can include joint and tendon releases, tendon transfers and joint fusions.