Hammer, Claw & Mallet Toes
What are Claw, Mallet and Hammer Toes?
These are common deformities of the lesser toes and are named based on the toe joints affected. In the lesser toes, there are three bones and two interphalangeal joints.
The bones: proximal phalanx, middle phalanx, and distal phalanx.
The joints: proximal interphalangeal joint (PIPJ), and distal interphalangeal joint (DIPJ).
With hammer toes, the proximal phalanx extends upwards, the PIPJ is flexed, the middle phalanx points downwards and the distal phalanx is in line with the foot.
Mallet toes affect the DIPJ and distal phalanx. The DIPJ is flexed and distal phalanx points downwards.
Claw toes are a combination of both hammer and mallet toes, where both the PIPJ and DIPJ are flexed.
These three toe deformities develop gradually and are strongly linked with poor fitting footwear and / or a long toe. Pressure at the tips of the toe can cause the toes to ‘buckle’ at either of the interphalangeal joints. With the toes regularly held in this shape, the early stages involve the tendons starting to tighten creating a semi permanent toe shape but flexion at the joints can be corrected with pressure. Over longer periods of time, the tendons can tighten further and joints become flexed in a rigid position.
Symptoms vary depending on the type of deformity.
Hammer Toe Symptoms
With the proximal phalanx extended upwards, this can typically increase pressure under the metatarsophalangeal joint, and the top of the PIPJ. This can lead to pain and degeneration under the MTPJ and / or wound and corn to the top of the PIPJ.
Mallet Toe Symptoms
These typically affect the nail and tip of the toe. This can develop a thickened and painful nail and / or callus and wound at the tip of the toe.
Claw Toe Symptoms
A combination of the problems of hammer and mallet toes.
Treatments vary depending on the severity of the deformities and symptoms, and can be classified into conservative and surgical treatments
These include wearing footwear with enough space in the toe boxes, orthotic devices to offload high pressure areas under the foot, taping the toes down to keep them straight, and tendon stretches.
These can include tendon lengthening, toe shortening, and joint fusion.
Helpful Hammer Toe Exercises
Reduce the deformity to a straight toe as much as possible. While keeping the toe straight, gently lift the toe upwards so you feel a pull underneath the toe / foot. Hold this for 30 seconds and repeat 3 times a day. While keeping the toe straight, gently flex the toe downwards so you feel a pull on top of the toe / foot. Hold this for 30 seconds and repeat 3 times a day.
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