Hammer toe surgery

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What is a hammer finger?

The hammer finger is a deformity of the finger involving hyperextension in the metatarsophalangeal joint and flexion contracture in the proximal interphalangeal joint. Bad position of the toes results from the imbalance of tensions between the muscles that straighten and flex the fingers, as well as the atrophy of the muscles stabilizing the phalanges of the fingers.

Symptoms

Toe deformity increases the risk of a clash between the phalanx and the footwear. The constant pressure of the phalanx causes painful abrasions and calluses on the dorsal side of the finger above the affected joint. When the toes are lifted, the heads of the metatarsal bones place increased pressure on the sole of the forefoot, resulting in painful thickening of the skin (calluses). The hammer finger in most cases is associated with transverse flatfoot and hallux valgus, which moves towards the other finger. In the advanced stage of hallux, the big toe overlaps the adjacent toe, forcing it to be lifted and maintaining its hammer shape. When looking down at the foot, the bunion and the other toe (sparrowhawk) intersect.

The causes of deformation of the toes

The main cause of the disease is wearing the wrong footwear. Too tight or narrow shoes cause squeezing, sometimes even crushing the toes. High heels shift the weight of the body to the front of the foot and lead the foot to slide towards the toe of the shoe. In addition, long-term keeping of the metatarsal joints in dorsiflexion causes the heads of the metatarsal bones to be pressed against the sole of the foot. People who place their feet incorrectly on the ground, putting their feet mainly on the forefoot, develop painful transverse flat feet more often.

When the foot is inside a high heel or tight shoe, the muscles in the feet cannot work properly. After a long period of using inappropriate footwear, the muscles governing the movement of the fingers cease to be properly activated even when walking barefoot. The internal muscles of the foot that stabilize the toes disappear, and the superficial muscles become more and more tense. It takes a long time to reverse this state of affairs. In order to prevent the formation of hammer toes, one should therefore avoid frequent wearing of poorly fitting shoes, especially too tight shoes and high heels.

Toe deformities are much more common in overweight people, because excessive body weight predisposes to a faster lowering of the transverse arch of the foot. Joint inflammation, such as in the course of rheumatoid diseases, also increases the risk of malformation of the hammer fingers.

Hammer toes are more common in people with the Greek type of foot (called Morton's foot), in which the second toe is the longest toe in the foot. Certain anatomical defects in the toe muscles also predispose the fingers to curl and tilt.

Hammer fingers and claw toes

The claw fingers differ from hammer fingers by the existence of an additional contracture in the distal interphalangeal joint. The hammer toe can be single and usually affects the second toe of the foot. The toes of claws are present simultaneously in all toes except the big toe. The development of the disease is favored by a disturbance of the muscle tone of the central origin (diseases of the central nervous system or neurological injuries).

Toe contracture also occurs in Lederhose's disease (a condition analogous to Dupuytren's contracture in the hand). The cause of tucked fingers in Lederhose disease is fibrosis of the plantar fascia. It is very important to distinguish claw or hammer fingers from the deformities of the fingers present in Lederhose disease.

How to deal with hammer fingers?

The choice of the procedure depends on the degree of correctness of the crooked finger. In the early stages, the deformity is still corrective, which means that it is possible to straighten the finger manually. During this period, activities are aimed at maintaining the extension of the PIP joint while maintaining a neutral position of the metatarsophalangeal joint

Hammer finger rehabilitation

Finger rehabilitation focuses on relaxing excessively tense and shortened muscles and on manual mobilization of selected joints. In order to consolidate the effects of the therapy, the physiotherapist puts a plaster on the finger, which keeps the finger in the corrected position.

Hammer fingers - exercises

The exercises are designed to improve the mobility of the fingers and stimulate the muscles that stabilize the proximal phalanges to work. Examples of hammer finger exercises are:

fan-shaped spreading of fingers,
single finger movement,
straightening the toes,
pressing straightened fingers against the ground.

Hammer-toe braces

There are various types of orthoses and hammer finger guards available in medical stores. The hammer finger bandage reduces finger deformation, and thanks to the use of a soft material, it protects against abrasions and corns. The hammer finger brace more effectively places the finger in the corrected position and at the same time prevents the neighboring finger from curling up. When it comes to the use of orthoses, it is of great importance to choose the right footwear that easily fits all the fingers together with the orthosis, because only then can we be sure that the position of the fingers will remain correct.

Orthopedic insoles

The purpose of orthopedic insoles for hammer fingers is to raise the transverse arch with a metatarsal pad, thanks to which the positioning of the fingers is temporarily improved. The effect may only be noticeable if the deformation is corrective. Some stock hammer finger straightening inserts may have a finger shaft, however, due to the complex pathomechanics of the deformation, such an insert element is not desired.

Surgical treatment of hammer fingers

Over time, the finger becomes less and less flexible and we can no longer straighten it manually. A non-corrective stiff finger is only subject to surgical treatment. A corrective degree of distortion is also an indication for surgery if there is a problem with overlapping or rolling fingers.

The choice of the surgical method depends on the type of deformity (hammer or claw toes) and the degree of correctness of the defect. Corrective deformities are usually treated by tenotomy (cutting the flexor tendon) or by transferring the flexor tendons to the extensor

Non-corrective deformations require cutting the bones and removing the cartilage of the joint. Then arthrodesis (stiffening) of the interphalangeal joint can be performed. If the cause of the deformity is an excessively long toe or metatarsal, their length is shortened to avoid recurrence.

The finger is stabilized with internal anastomosis or wires, which are removed after about 4-6 weeks. As a result, a long-lasting effect of a straightened finger is obtained. The procedure often includes the correction of the hallux valgus and then it is part of a complex reconstruction of the forefoot. The surgeon corrects the front part of the foot to restore all of the toes to their correct shape.

Rehabilitation after hammer toe surgery

The patient wears normal footwear that does not hurt the place where the wire joining the bone fragments protrudes outside. After the operation, the finger may be slightly swollen and its mobility is reduced, but this does not affect the quality of gait.

Rehabilitation involves the mobilization of selected joints of the foot (except for those that have undergone arthrodesis). In order to consolidate the effects of the therapy, the physiotherapist puts a plaster on the finger to stabilize its correct position. It is very important to restore the correct load on the foot in the standing position and in the various phases of gait support. Taping to maintain the correct finger position is most important in the first month after the operation - immediately after it.

Due to the fact that hammer toes most often occur in people wearing too tight and poorly fitted shoes, it is important to educate patients in the field of shoe modification. After the operation, you must not go back to old habits and use high heels, because it could be associated with an injury to the operated toe.

Important information

Frequently asked questions about hammer fingers: