What are the treatment options for hammer toes?

Hammer Toe Treatment Options

Digital flexor tenotomy is strongly recommended as first-line surgical treatment for hammer toes when conservative treatment fails, especially in high-risk patients with pre-ulcerative signs or ulcers on the distal toe. 1, 2

Conservative Management Options

Conservative treatment should be attempted first for hammer toe deformities, especially in cases of flexible deformities:

• Footwear Modifications:

  • Wear properly fitting shoes with a wide toe box to accommodate the deformity 2
  • Use extra-depth shoes for patients with foot deformities or pre-ulcerative lesions 2
  • Avoid thin-soled slippers, walking barefoot, or wearing only socks 2
  • Consider therapeutic footwear with demonstrated plantar pressure-relieving effect (30% relief compared to standard footwear) 2

• Orthotic Devices:

  • Toe silicone or semi-rigid orthotic devices to reduce excess callus on toes 2
  • Felted foam combined with appropriate footwear when other biomechanical relief options aren't available 2
  • Metatarsal pads placed 6.5 mm proximal to the second metatarsal head can diminish peak pressures by 33% 3

• Skin Care:

  • Apply topical emollients to periungual folds and nail plate daily if nails are involved 2
  • Regular professional foot care for callus removal and nail treatment 1

• Novel Approaches:

  • Kinesiology taping may provide symptomatic relief for patients who cannot undergo surgery 4

Surgical Interventions

When conservative treatments fail, surgical options should be considered:

• Digital Flexor Tenotomy:

  • First-line surgical treatment for neuropathic plantar or apex ulcer on digits 2-5 with flexible toe deformity 2
  • High healing rate of 97% in a mean of 29.5 days 2
  • Can be performed in an outpatient setting with minimal resources 2
  • Low recurrence rates (0-20%) in treated patients 1
  • Few complications reported, making benefit-to-risk ratio favorable 2

• For Rigid Deformities:

  • Proximal interphalangeal joint arthrodesis (fusion) 5
  • Arthroplasty with resection of the head of the proximal phalanx 6
  • Subtraction osteotomy of the proximal phalanx neck (preserves joint function) 6
  • Fixation options include Kirschner wires (temporary) or permanent internal fixation devices 7

Monitoring and Follow-up

• Monitor patients with hammer toe deformities every 1-3 months, especially high-risk patients 1, 2
• Consider temperature monitoring to detect early inflammation 2
• Provide integrated foot care including professional foot treatment, adequate footwear, and education 1

Important Considerations

• For Diabetic Patients: Hammer toe deformities significantly increase ulceration risk, making proper management crucial for preventing serious complications 1
• Surgical Success Rates: Patient satisfaction rates after surgical correction approach 84-92%, with pain relief in up to 92% of patients 5, 7
• Fixation Methods: While K-wires have traditionally been used, newer permanent internal fixation options may reduce complications related to exposed wires 7
• Conservative Treatment Limitations: While conservative treatments can alleviate symptoms, they are not permanent solutions to the deformity and are best suited for elderly patients or those with low functional demands 3

Remember that early intervention is key to preventing progression of the deformity and associated complications, particularly in high-risk patients such as those with diabetes.