Hammer Toe & Claw Toe

A hammer toe (also called hallux malleus or digitus malleus) and a claw toe are both toe deformities that usually affect the second to fourth toes. These deformities are manifested by flexion in the middle phalanx of the toe. In claw toe, the proximal phalanx is also hyperextended, and the “claw-in” of the toes is also visually conspicuous in claw toe. In hammer toe, the end phalanx of the toe thereby points to the ground like a hammer. The constant contact therefore causes pressure points and thus pain. Even a slight misalignment can cause pain. Often, a hammer toe also brings with it a problem: “Finding suitable shoes becomes a real challenge,” says expert Dr. Klaus Pastl.

A hammer toe is the most common toe deformity. In many cases, those affected also suffer from other foot malpositions such as hallux valgus, splayfoot, flatfoot or high arch. Most often, a hammertoe develops during life and is rarely congenital.

There are many factors that can contribute to causing toe misalignment. One of these causes of a hammer toe is the wrong footwear. Because shoes that are too small, too narrow or too high can compress the toes, which can weaken the foot muscles. This causes the toes to become less and less controllable. Initially, the deformity of the toe can still be bent by hand, but in later stages the toe remains in its bent position and a hammer toe/claw toe develops.

In addition, patients who have pre-existing foot conditions may be more likely to develop hammertoe/claw toe than patients who do not have pre-existing foot conditions. Common diseases and pre-existing conditions include flatfoot, splayfoot, high arch or hallux valgus. “These pre-existing conditions lead to an incorrect load on the foot and can thereby promote a hammer toe” according to hammer toe & claw toe experts, Dr. Klaus Pastl & PD Dr. Puchner, who relies on Shark Screw® for surgery to correct deformities.

It often happens that after accidents, the so-called compartment syndrome occurs. This impairs blood circulation and subsequently irreversibly disrupts the function of muscles and nerves. This can cause the toe muscles to tighten incorrectly, and hammertoes as well as claw toes can form.

Rheumatism, a chronic joint inflammation, can also promote the development of claw toes and hammer toes, as it usually occurs in the toe joints as well.

It doesn’t always have to be that a hammer toe or claw toe will necessarily cause problems or pain. Most of the time, it is more of a purely cosmetic problem. At this stage, surgery is not recommended. However, if the deformity progresses further, hammertoes and claw toes may develop more horny calluses like corns on the toes and balls of the feet. As a result, sufferers may experience severe pain when wearing shoes and are restricted in their movement. The malposition can also displace other toes. “In the worst case, these can even be dislocated in the basic joint and thus lose their functional ability,” says specialist PD Dr. Puchner from Vienna.

The symptoms occur regardless of the severity of the claw toe or hammer toe. Thus, a slight malposition can already cause enormous pain, whereas again a severe toe malposition does not cause any problems for some sufferers. The sensation of pain varies from person to person. If you are unsure, we recommend that you seek advice from an orthopedist and podiatrist.

In most cases, a visual diagnosis is sufficient for hammertoe and claw toe, as they have a very characteristic appearance. The attending physician then checks the mobility of the toe. A distinction is made between a stiff (contracted) hammer toe and a flexible hammer toe. In the case of a flexible form of hammer toe, the doctor can compensate for the curvature by pressing on the sole of the foot. This is not the case with a contracted form of the hammer toe. The distinction between the two forms is important for the course of further treatment.

Basically, a distinction is made between conservative and surgical methods for hammer toe & claw toe. However, this depends on how pronounced the toe malposition is and whether the toe can still be passively extended. If the deformity is still in its early stages, conservative, i.e. non-surgical methods should be tried first to get the symptoms of the hammer toe or claw toe under control. It can already be helpful to widen the toe box in shoes. It is therefore advisable to give the toes more space in the shoe so that curvature can be prevented. Furthermore, so-called orthoses or padding and felt rings can prevent the hammer toe & claw toe from developing further and the symptoms from worsening. Special orthopedic insoles for shoes also prevent the development of pressure damage. Toe gymnastics as well as adequate foot care also contribute greatly to preventing hammertoes or claw toes, or stopping them in their progression. Patients often ask the question: Can a hammer toe / claw toe be taped? Taping the hammer toe or claw toe stabilizes the toe and keeps it in place. Especially with a slight curvature hammertoes & claw toes can be corrected so. However, tapes do not in any case cause the existing curvature to regress.

If the success of conservative methods does not last and the hammertoe/claw toe does not show improvement, hammertoe/claw toe surgery should be considered. There are various surgical methods that are used depending on the degree of toe malposition. Thus, whether the toe can still be moved and how much the toe is curved is critical. Surgery for a hammer toe or claw toe usually takes 15 to 20 minutes. These operations are usually performed under general or local anesthesia. “A very gentle method to correct a hammer toe or claw toe is by means of Shark Screw®. This eliminates the risk for the patient of a second operation to remove the metal, since Shark Screw® is converted to the patient’s own bone,” advises the hammertoe and claw toe expert from Linz, Dr. Klaus Pastl.

Before hammertoe & claw toe surgery, the doctor distinguishes between a contracted deformity and a flexible deformity. The doctor will examine your toe and assess how well it can still move. Depending on this, different surgical techniques are used. The following techniques for hammer toe /claw toe surgery are explained here:

PIP arthrodesis is one of the most common surgical methods for hammertoe or claw toe deformity. In the process, the joint surfaces are removed and subsequently joined. This means that the affected, contracted and painful hammertoe joint is stiffened. This is usually done with a screw made from human bone, since cells can migrate from one bone fragment to the other via the screw, which usually allows the two joint ends to grow together well. Another option is to connect these joint surfaces with a metal wire. However, the patient bears the risk that germs may enter the wound at the point where the wire protrudes from the skin. In addition, these wires must be removed again during a second operation.

In Hohmann’s surgery, the toe bone is shortened and part of the joint is removed. The affected toe becomes shorter as a result. The tactile function, and thus the stability, is impaired. The soft tissues, such as the tendons, are relieved.

The Weil osteotomy can only be performed in cases of flexible malposition. This involves cutting through the bone in the area of the metatarsal head, which leads to relaxation of the soft tissue situation and correction of the malposition. A Weil osteotomy is also often used for metatarsalgia. The two bone fragments are joined with screws made from human bone.