Hammertoes and Claw Toes: Primary and Revision

Abstract

Digital hammertoe and claw toe deformities of the forefoot remain a constant challenge to the foot and ankle surgeons daily. Patients often present with complaints of painful callosities on the dorsal or distal aspect of the affected digit with or without concomitant pain under the lesser metatarsophalangeal joints (MTPs). Digital contractures cause a retrograde pressure on the metatarsal heads leading to this “metatarsalgia” or plantar forefoot pain. The etiology is multifactorial and often treated nonoperatively with prefabricated or custom orthoses, padding, shoe gear modification, and taping. The lesser toe deformities can be associated with hallux abducto valgus deformities, pes plano valgus, neuromuscular disorders, and ankle equinus and can lead to pathologic plantar plate ruptures of the MTPs. When conservative management has failed, surgical intervention is necessary to provide adequate joint stability and pain reduction. The appropriate etiology and accurate diagnosis must be identified in order to provide the best treatment and surgical plan for each patient.