Merck Manual

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Hammer Toe Deformity


Kendrick Alan Whitney

, DPM, Temple University School of Podiatric Medicine

Reviewed/Revised Oct 2021 | Modified Sep 2022
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Hammer toe is a Z-shaped deformity caused by dorsal subluxation at the metatarsophalangeal joint. Diagnosis is clinical. Treatment is modification of footwear and/or orthotics.

The usual cause of hammer toe deformity is misalignment of the joint surfaces due to a genetic predisposition toward aberrant foot biomechanics and tendon contractures. Rheumatoid arthritis (RA) Rheumatoid Arthritis (RA) Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily involves the joints. Rheumatoid arthritis causes damage mediated by cytokines, chemokines, and metalloproteases.... read more Rheumatoid Arthritis (RA) and neurologic disorders such as Charcot-Marie-Tooth disease (see Hereditary Neuropathies Hereditary Neuropathies Hereditary neuropathies include a variety of congenital degenerative peripheral neuropathies (eg, Charcot-Marie-Tooth disease). (See also Overview of Peripheral Nervous System Disorders.) Hereditary... read more ) are other causes. The 2nd toe is the most common digit to develop a hammer toe deformity (see figure Hammer toe Hammer toe Hammer toe ). Second toe hammer toes commonly result from an elongated 2nd metatarsal and from pressure due to an excessively abducted great toe (hallux valgus deformity) causing a bunion Bunion Bunion is a prominence of the medial portion of the head of the 1st metatarsal bone. The cause is often variations in position of the 1st metatarsal bone or great toe, such as lateral angulation... read more . Unusually long toes often develop hammer toe deformities. Painful corns Calluses and Corns Calluses and corns are circumscribed areas of hyperkeratosis at a site of intermittent pressure or friction. Calluses are more superficial, cover broader areas of skin, and are usually asymptomatic... read more Calluses and Corns often develop in hammer toe deformity, particularly of the 5th toe. Reactive adventitial bursas often develop beneath corns, which may become inflamed.

How to Examine the Foot
How to Examine the Ankle

Hammer toe

In hammer toe, usually the 2nd toe, or sometimes another lesser toe, develops a fixed Z-shaped deformity.

Hammer toe

Treatment of Hammer Toe Deformity

  • Wide toe box, toe pads, orthotics, or a combination

People with hammer toe should where shoes with a wide toe box. Toe pads sold in pharmacies also help by shielding the affected toes from the overlying shoe. If conservative measures are ineffective, surgical correction of the deformity often relieves symptoms. If there is accompanying metatarsalgia, over-the-counter or prescription orthotic devices with metatarsal pads and cushioning may help alleviate the pain.

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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