Hammer Toes

In this episode of PodMD, director and principal podiatrist of the Brimbank foot & ankle clinic Mr Tristan Fairbairn will be discussing the topic of hammer toes, including what hammer toes are, the risks of the condition, the treatment options, the likelihood of recurrence, when to refer and more.

  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Mr Tristan Fairbairn

    Tristan is a podiatrist providing care in Melbourne’s northern and western suburbs, and is the director and principal podiatrist at the Brimbank foot & ankle clinic. He is currently undertaking extensive postgraduate training to become a podiatric surgeon, and is also endorsed by the Podiatry Board of Australia to prescribe scheduled medicines.
    Tristan has been working in private practice for 15 years and is skilled to treat/perform general podiatry issues, biomechanical and musculoskeletal injuries, minor soft tissue procedures, injection therapy, orthotic therapy, and fracture management.

    Today, we’ll be discussing the topic of Hammer Toes.

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Tristan, thanks for talking with us on Pod MD today.

    Tristan: Thanks for having me.

    Question 1
    The topic of today’s discussion is hammer toe. Can you describe for our listeners what hammer toe is?

    Tristan: Hammertoes are a fairly common lesser toe deformity, and we know basically it’s characterised by flexion of the proximal interphalangeal joint, extension of the distal interphalangeal joint, and sometimes it involves extension of the metatarsophalangeal joint.

    Question 2
    How would a patient with hammer toe typically present?

    Tristan: There’s a few presentations that patients will typically present with. First of all, it will be different if it’s a rigid or a flexible deformity, but typically a patient will present with a build up of hard skin or corns over the dorsal interphalangeal joint or under the plantar aspect of the metatarsophalangeal joint. They also may experience plantar plate pain, which can create significant joint pain under the ball of the foot.

    Question 3
    What are the risks of not treating the condition?

    Tristan: The main risks associated with this problem is ongoing pain and deformity that will not only impact upon the toe itself, but the patient’s ability to walk freely and unrestricted.

    Question 4
    What are the treatment options?

    Tristan: There’s a number of options available and that can be broken down into non-operative and operative.
    When it comes to non-operative, the mainstay of treatment will involve capacious and wide deep shoe gear to accommodate the deformity, along with the use of protective devices such as silicone gel to sleeves or joint protectors. In some cases, we utilise foot orthoses to help with redistributing pressures under the foot. Typically, the patient will require some type of ongoing management of the corns, where they may have to attend their podiatrists for routine care.
    In terms of operative, there’s a number of options that involve straightening of the toe, and this ultimately depends whether or not it’s a flexible or rigid deformity.

    Question 5
    Have there been any developments in treatment in the last years or are there any in trials or development now?

    Tristan: In terms of conservative management, the previously outlined modalities are fairly well used and maintained in current podiatric treatments. However, when it comes to surgical management, there has been a shift toward minimally invasive techniques where osteotomies and tendon releases are made through small portals, as opposed to the traditional open techniques where joint arthroplasties and arthrodesis are performed.

    Question 6
    Are there any warning signs a GP, podiatrist or their patient can look out for?

    Tristan: Yes, there is. In terms of hammer toe, there’s a number of concerns. First of all, with respect to the patient, it’s important to establish if the patient has any underlying neurovascular compromise, because given the pressure lesions, this can result in further ulceration and deformity. Obviously, if that isn’t the case, ongoing pain and deformity is the main issue.

    Question 7
    What is the likelihood of recurrence of the condition?

    Tristan: If the condition is being managed conservatively, it’s likely that the structural deformity will remain, however, it’s just managed. With respect to surgical intervention, there is a small chance of recurrence depending on the actual procedure that is undertaken.

    Question 8
    When should a GP or podiatrist refer?

    Tristan: A referral should be undertaken if all non-operative conservative modalities have been explored and failed accordingly. Otherwise, if the deformity appears excessive or gross, the referral is warranted.

    Question 9
    What role does the GP or podiatrist play in the treatment of the condition?

    Tristan: As for the podiatrist, they play an important role in footwear education and prescription, as well as the advice and implementation of various protective modalities, including toe splints and foot orthoses. They also play an important role in managing any secondary corn or callus build-up.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on hammer toes?

    Tristan: Hammer toes are a common digital deformity that will typically impact upon the second toe. There are a number of non-operative and operative treatment options available for each patient. If everything fails, it’s important to refer for surgical intervention.

    Thanks for your time and the insights you’ve provided.

    Tristan: Thanks very much.

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.