What is the treatment for hammertoe (flexion deformity of the toe)?

From the Guidelines

For hammertoe, especially in individuals with diabetes at risk of foot ulceration, consider digital flexor tendon tenotomy as a valuable procedure to help prevent a first or recurrent foot ulcer, as it has moderate desirable effects and few reported complications 1. When managing hammertoe, it's crucial to address the underlying causes, such as muscle imbalances, ill-fitting footwear, or foot structure abnormalities, to prevent long-term complications.

• Conservative treatments should be the initial approach, including wearing shoes with a wide, deep toe box and using cushioned pads to reduce pressure and friction.
• Daily toe exercises, like picking up marbles or manual stretching, can help strengthen muscles and maintain flexibility.
• Over-the-counter pain relievers, such as ibuprofen (200-400mg every 6-8 hours) or acetaminophen (500mg every 6 hours), can manage discomfort.
• For more severe cases, custom orthotic inserts may redistribute pressure, and if the hammertoe is flexible, these non-surgical approaches are often effective. However, if the toe becomes rigid or pain persists despite conservative measures, consulting a podiatrist for potential steroid injections or surgery is necessary, with surgery typically involving tendon transfers, joint resections, or fusion procedures depending on the severity 1. It's also important to consider orthotic interventions, such as toe silicone or (semi-)rigid orthotic devices, to help reduce excess callus on the toe, especially in individuals with diabetes at risk of foot ulceration 1.

From the Research

Treatment Options for Hammertoe

• Conservative management is the first line of treatment for hammertoe, which can include proper shoewear, orthoses, and inserts coupled with targeted physical therapy 2
• If conservative care fails, surgical management may be considered, including interphalangeal joint arthroplasty, arthrodesis, and/or plantar plate repair 3
• Percutaneous surgical techniques can also be used to manage hammer toe deformity, and a treatment algorithm can be followed for effective management 4

Factors to Consider for Treatment

• The best surgical plan must be patient-centered, taking into account the age, activity level, expectations of the patient, and precise etiology of the hammertoe deformity 3
• Effective diagnosis requires robust clinical examination and radiographic imaging or MRI 4
• The cause of pain and the classification of metatarsalgia (primary, secondary, or iatrogenic) can help guide conservative management 2

Management of Hammertoe Deformity

• Hammer toe deformity is a highly prevalent lesser toe deformity that can be caused by extrinsic and intrinsic muscular imbalance, attenuation and subsequent rupture of the plantar plate, and neuromuscular disorders 4
• Conservative management can often alleviate most symptoms of metatarsalgia and lesser toe deformities, and can obviate surgical intervention 2