Hammer toe

Disease Description (Causes and Symptoms)

• Definition: Hammer toe is a deformity in which the first joint of the toe (the proximal interphalangeal joint, PIP) bends, creating a hammer-like shape.
• Causes and pathophysiology: Long-term wearing of tight or narrow-toe shoes and high-heeled shoes places pressure on the top of the toes, causing an imbalance between the flexor and extensor muscles and gradually bending the PIP joint into a fixed (rigid) position. Congenitally long second toes, trauma, or neuromuscular abnormalities (rarely) may be causes. As it progresses, joint contracture and arthritis may develop.
• Main symptoms: Bent toe, pain in the toe area, calluses (corns) or hardened skin on top of the toe, tenderness when wearing shoes, and an increased risk of skin ulcers and infection in people with diabetes or reduced sensation.

Treatment Methods

• Conservative treatment (mainly for early-stage and flexible deformities)
  • Shoe modification: Wear comfortable shoes with a wide toe box and sufficient space, with low heels.
  • Protectors and pads: Cushions to reduce pressure on calluses, toe pads, and silicone toe spacers.
  • Orthoses/taping: Splints and taping that help with stretching at night or during activities.
  • Physical therapy and stretching: Toe flexor and extensor muscle stretching and strengthening exercises.
  • Custom insoles (orthotics) or walking aids to redistribute pressure.
  • Pain control: Short-term oral nonsteroidal anti-inflammatory drugs (NSAIDs) or topical analgesics.
• Surgical treatment (when conservative treatment fails or when there is a fixed deformity or severe pain)
  • Soft-tissue surgery: Tendon release or joint capsule excision, among other procedures.
  • Arthroplasty: A method of straightening the toe by removing part of the deformed joint.
  • Arthrodesis: Joint fixation when stability is needed or there is a risk of recurrence.
  • Bone correction procedures such as osteotomy may also be performed.
  • The extent of the deformity and joint condition are assessed with X-rays before surgery. Most procedures are performed on an outpatient basis or with a short hospital stay, and the anesthesia method is determined according to the patient’s condition.
• Precautions and risk of complications
  • Patients with diabetes or peripheral vascular disease have a higher risk of delayed wound healing, infection, and ulcers and require additional care.
  • If left untreated, joint fixation (stiffness), arthritis, persistent pain, difficulty wearing shoes, skin ulcers, and infection may occur.
  • Postoperative complications: Infection, nerve injury, nonunion, and possible recurrence.
• Precautions for self-management
  • Make appropriate shoe selection a regular habit and check the condition of the feet (calluses and wounds) regularly.
  • If you have diabetes, carefully control your blood sugar and maintain foot hygiene; seek medical attention immediately if there are changes in skin color or sensation in the feet.
  • Consult an orthopedic specialist if conservative measures do not improve the condition or if pain or functional impairment is severe.

Outpatient Visit Checklist (Items to Bring and Testing History, etc.)

• Items/materials to bring
  • Current medications (including prescriptions and English names) and a history of allergies.
  • History of previous surgery and trauma (especially involving the feet).
  • Information about coexisting conditions such as diabetes, peripheral vascular disease, and neuropathy.
  • Previously taken foot X-rays or other imaging materials, if available.
  • Notes recording when the symptoms began and how they have progressed (location and intensity of pain, aggravating factors, and relieving factors).
  • Photos of shoes worn frequently or the actual shoes.
• Information to check during the outpatient visit (providing this to the doctor can help with diagnosis and treatment planning)
  • Degree of pain (pain elasticity, visual analog scale) and whether there is discomfort when walking.
  • Presence or absence of calluses, wounds, bleeding, or discharge (taking photographs is recommended).
  • Foot-use patterns in daily life and at work (standing for long periods, frequency of wearing narrow shoes).
  • Conservative treatments previously attempted (pads, splints, insoles, etc.) and their effects.

Examples of General Questions to Ask the Doctor

• Is this condition progressive? What is its natural course and prognosis?
• When is surgery recommended? What are the benefits and risks of surgery?
• What conservative treatments (shoes, insoles, splints, etc.) are recommended, and how long should they be tried?
• What are the side effects of medications for pain relief?
• How long is the recovery period after surgery, and when can I return to daily activities and resume exercise?

Examples of Condition-Specific Questions

• Is my toe deformity still flexible (with mobility), or has it already become stiff, and based on this, which treatment (nonsurgical versus surgical) is recommended?
• I have diabetes and peripheral vascular disease. Do I need any special preparation or management to reduce the risk of wound-healing problems and infection during surgery (such as blood sugar targets or preventive antibiotics)?