Hammertoe

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In podiatry, a hammertoe is the lay description of contracted digits of the foot. Generally speaking, contracture at the distal interphalangeal joint is called a mallet toe, contracture only at the proximal interphalangeal joint a hammertoe, while contracture of both joints is called a claw toe.

The eitology of a hammertoe is thought to occur through three processes; flexor stabilization, extensor subsitution and flexor subsitution.

Flexor Stabilization

This is by far the most common cause of a hammertoe occurring in over 90% of all hammertoes. During the midstance portion of the gait cycle, pronation of the subtalar joint leads to unlocking of the midtarsal joint (calcaneal-cuboid joint and talo-navicular joints). Unlocking of the midtarsal joint leads to hypermobility of the forefoot. The long flexor tendon (Flexor digitorum longus) pulls sooner in the gait cycle to stabilize the forefoot. Because this tendon is firing longer in the gait cycle, it overpowers the intrinsic musculature of the foot to cause a hammertoe.

Extensor Subsitution

This is considered the least common cause of a hammertoe. It occurs in the swing phase of the gait cycle in patients who have a cavus foot or in patients who have a drop foot. The extensor digitorum longus fires for a longer period in the gait cycle to achieve ground clearance. This overpowers the intrinsic muscles causing contraction of the digits.

Flexor Subsitution

This occurs with weakness of the superficial posterior muscle group in the calf. In the heel off stage of the gait cycle, the long flexor muscle in the deep posterior group fires longer in an attempt to lift the heel off the ground. This in turn, overporwers the intrinsic muscles of the foot leading to contracted digits.

Self-care / Therapy

While there are surgical options for treatment of severe or advanced Hammer Toe Deformity, a perpetual Self-Care program may be beneficial. We recognize that the tendons along the top (dorsum) of the foot have contracted with time and disuse. This causes the characteristic claw-like appearance of the toes (middle knuckle elevated and toe tip pointing downward).

Physical therapists recommend spending 3 to 5 minutes each morning and evening massaging and stretching the foot. This can be accomplished as one puts on and takes off the shoes each day. Stretch the fore-foot downward, flattening the toes and pointing them towards the bottom of the foot. Maintain enough pressure to feel the stretch in the tendons on top of the foot. After five seconds, release, massage, and then repeat the process for 3 to 5 minutes total time for both feet.

Also, lay a broomstick on the ground and, with the shoes removed, stand with your toes overlying the broomstick perpendicularly. Curl your toes down along the side of the broomstick several times (3 sets of 10 repetitions). This strengthens the small muscle groups in the bottom (plantar) surface of your feet.

In combination these two therapy practices can result in significant improvement, if not complete resolution of Hammer Toe deformity within a six month time frame. Understand though, the primary problem is a lifetime of habit involving your gait (walking pattern). As such, the practices described above are recommended as a lifelong process of treatment and subsequent prevention of regression.