HAMMER TOES & MALLET TOES
A hammertoe or mallet toe is a deformity in which the toe is curled downward toward the floor. Lesser toe deformities are commonly associated with poor footwear selection, but also can be secondary to hereditary causes. They are seen more commonly in women than in men. A mallet toe occurs at the tip of the toe. A hammertoe occurs more proximal, closer to the junction of the toe to the foot. Pain develops at multiple areas on the toe as it strikes the bottom of the shoe sole and the top of the toe box. In some cases, a callous, an ulcer, or an infection may result from continued pressure on the toe. Patients often experience pain, which is worse with activity and tightly fitting shoes. Patients may be dissatisfied with the function and appearance of the contracted angled toe.
Treatment of lesser toe deformities is aimed at relieving pain and preventing recurrence or progression of the deformity. Utilization of an athletic shoe with a flat heel and a wide toe box may help keep pressure off of the toes. Sometimes prominent areas can be padded with silicone toe sleeves or other types of cotton padding, which may provide pain relief. Some patients find that taping the toe down or buddy taping the toe to neighboring toes may help with alignment and pain. A stiff-soled shoe or a rigid insert may help splint the forefoot and decrease bending forces on the toes. Anti-inflammatory medications may help decrease painful inflammation and swelling.
When pads and footwear modifications are unsuccessful, surgical intervention may be considered. Hammertoes and mallet toes are generally successfully treated with resection of the bony prominence and straightening of the toe. Often a small removable pin is placed in the toe in order to maintain the correction while healing occurs. Less frequently, for more severe deformities or recurrent deformities, a permanent implant can be placed in the toe to maintain alignment. Following surgery, careful postoperative care is needed in order to keep the toes in proper alignment while healing occurs. Usually patients do not need to spend the night in the hospital after a hammertoe or mallet toe surgery. Stitches are usually removed at 2-3 weeks after surgery. If a pin has been placed in the toe, it is usually removed in the office at about 4-6 weeks after the operation. You will likely be able to bear weight on your heel the first week after surgery. Although we will allow you to put weight on your heel, to help insure a good outcome, we will ask you to walk flat-footed for about 6 weeks without putting pressure on your toes. A walking boot with toe-taping will provide additional protection. Transitioning back into a regular shoe usually occurs around 6-8 weeks after surgery and at this point you can begin walking with a more normal gait pattern. Impact activities such as jogging usually take at least 12 weeks before they can be done safely. Time off from work depends on the occupation but prepare to take off at least 1 week because elevation of the foot is very important in the immediate postoperative period.