What is a hammer/claw toe?
A hammer or claw toe deformity typically affects the lesser toes. In a hammer toe deformity, the toe is bent at the middle joint, resembling a hammer. A hammer toe is the most common deformity of the lesser toe and results from an imbalance of the pull of the muscles which extend and flex the toes. With a claw toe deformity, the lesser toe is curled up and bent at the interphalangeal joints into a claw position. Clawing of the lesser toes is usually genetic or associated with nerve injury. Like bunions, these deformities are initially flexible, but can progress and become fixed over time.
What are common symptoms associated with a hammer/claw toe?
Patients with deformity of their lesser toes can present with callosities over the prominence of the top or tips of their toes and may have pain from rubbing in footwear or against adjacent toes. If severe or neglected, this can develop into a pressure area ulcer and cause infection. For advanced or long-standing deformities, patients may also experience pain under the ball of their forefoot on weight-bearing, or have metatarsalgia.
How can a hammer/claw toe be managed?
Non-operative management options for a hammer/claw toe deformity include wearing supportive and accommodative shoes with a wide and high toe box, using footwear aids such as a hammer toe splint, toe sleeve and/or a metatarsal dome orthotic for any associated plantar metatarsalgia, and with simple over-the-counter oral analgesia and/or oral anti-inflammatory medication if not contraindicated as required.
What is the surgical treatment for a hammer/claw toe?
Surgical correction of a hammer or claw toe deformity may be necessary if the aforementioned strategies fail. This usually involves a combination of soft tissue and bony procedures, and may include releasing or lengthening a tendon (tenotomy), cutting or performing an osteotomy of the metatarsus or phalanx, and/or fusing an interphalangeal joint in the affected toe.
What is the recovery after lesser toe correction surgery?
After your hammer/claw toe correction, you can full weight-bear straight away on your operated foot, but will need to wear a flat Darco shoe for 6-8 weeks, after which you can then transition to stiff-sole normal supportive footwear with a spacious toe box. Once your surgical dressings have been removed after 2 weeks and your wounds are healed, you will be encouraged to desensitise your surgical scars by massaging your wounds with a moisturising cream/oil. You may have a wire protruding from the end of your toe which is removed in the clinic after 6 weeks. For most patients, it will take 2-3 weeks for your wounds to heal, 3-4 months for your lesser toe joint fusion/osteotomy to unite, 5-6 months before you are reasonably comfortable walking in normal supportive shoes, and up to 12 months for the swelling in your foot to subside and for full recovery to your new baseline level.