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Hammer Toes and Mallet Toes

A hammertoe, mallet toe, or claw toe is a deformity in which the toe is curled downward toward the floor. Lesser toe deformities are commonly associated with poor footwear selection, but also can be secondary to hereditary causes. They are seen more commonly in women than in men. A mallet toe occurs at the tip of the toe. A hammertoe occurs more proximally, closer to the junction of the toe to the foot. A claw toe may include curling of the entire toe on multiple toes. Pain develops on both the top and bottom of the toe as the toe tip strikes the shoe sole and the knuckle rubs the top of the toe box. In some cases, a callous, an ulcer, or an infection may result from continued pressure on the toe. Patients often experience pain, which is worse with activity and tightly fitting shoes. Patients may be dissatisfied with the function and appearance of the contracted angulated toe. When the capsular restraints and plantar plate tears, the toe may begin to deviate to the side, or start to raise off the floor. Patients often complain of pain at the base of the toe with activity related discomfort. The toe may appear to be out of alignment.

Surgical Intervention

Following surgery, careful postoperative care is needed in order to keep the toes in proper alignment while healing occurs. Patients generally do not spend the night in the hospital after a hammertoe or mallet toe surgery. Stitches are usually removed at 2-3 weeks after surgery. If a pin has been placed in the toe, it is usually removed in the office at about 4-6 weeks after the operation. Sometimes a permanent implant may be placed in the toe to help maintain correction. A permanent implant may be more commonly used with severely contracted toes or for revision surgeries. Sometime with severe neurogenic clawing seen after a stroke or injury implants will be placed in multiple toes to straighten them. You will likely be able to bear weight on your heel the first week after surgery. Although we will allow you to put weight on your heel, to help insure a good outcome, we will ask you to walk flat-footed for about 6 weeks without putting too much pressure on your toes. A walking boot or hard-soled post-operative shoe may provide additional protection. Transitioning back into a regular shoe usually occurs around 6 weeks after surgery, and at this point you can begin walking with a more normal gait pattern. Impact activities such as jogging usually take at least 8-12 weeks before they can be done comfortably. Time off from work depends on the occupation but try to take off at least 1 week because elevation of the foot is very important in the immediate postoperative period.

Conservative Treatment

Treatment of lesser toe deformities is aimed at relieving pain and preventing recurrence or progression of the deformity. Utilization of an athletic shoe with a flat heel and a wide toe box may help keep pressure off of the toes. Sometimes prominent areas can be padded with silicone toe sleeves or other types of cotton padding, which may provide pain relief. Some patients find that taping the toe down or buddy taping the toe to the neighboring toes may help with alignment and pain. A stiff-soled shoe or a rigid insert may help splint the forefoot and decrease bending forces on the toes. Anti-inflammatory medications either topically or orally may help decrease painful inflammation and swelling.
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