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Hammertoe Deformity Workup

  • Author: Anthony Watson, MD; Chief Editor: Anthony E Johnson, MD  more...
Updated: Mar 28, 2016

Laboratory Studies

Serologic evaluation—including determinations of the rheumatoid factor, antinuclear antibody, human leukocyte antigen (HLA) B27, and Lyme titers if inflammatory arthropathy is suspected—should be considered.


Imaging Studies

Radiographic evaluation of hammertoe is not necessary for clinical diagnosis; however, it can be helpful for ruling out alternative diagnoses and can aid in surgical planning. Imaging considerations in the evaluation of hammertoe deformity include the following:

  • Weightbearing anteroposterior and lateral radiographs of the involved foot are useful
  • Intra-articular or periarticular erosions suggest rheumatoid arthritis or psoriatic arthritis, respectively.
  • Enlargement of the metatarsal head and osteophytes suggests a previous Freiberg infraction.
  • Varus angulation and/or dorsal subluxation or widening of the joint space of the MTP joint suggests MTP instability.
  • The presence of other deformities should be noted

Histologic Findings

Histologic evaluation is typically not available or necessary before hammertoe treatment. Skin ulceration and osteomyelitis may occur in neuropathic patients with hammertoe deformity. Histologic confirmation of osteomyelitis precludes most hammertoe reconstruction procedures.

Contributor Information and Disclosures

Anthony Watson, MD Orthopedic Surgeon, Private Practice

Anthony Watson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Pennsylvania Orthopaedic Society, American Orthopaedic Foot and Ankle Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Anthony E Johnson, MD Chairman, Department of Orthopaedic Surgery, San Antonio Military Medical Center; Research Director, US Army–Baylor University Doctor of Science Program (Orthopaedic Physician Assistant); Custodian, Military Orthopaedic Trauma Registry; Associate Professor, Department of Surgery, Baylor College of Medicine; Associate Professor, The Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences

Anthony E Johnson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Healthcare Executives, American College of Sports Medicine, American Orthopaedic Association, Arthroscopy Association of North America, Association of Bone and Joint Surgeons, International Military Sports Council, San Antonio Community Action Committee, San Antonio Orthopedic Society, Society of Military Orthopaedic Surgeons, Special Operations Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Society of Military Orthopaedic Surgeons; American Academy of Orthopaedic Surgeons<br/>Received research grant from: Congressionally Directed Medical Research Program<br/>Received income in an amount equal to or greater than $250 from: Nexus Medical Consulting.

Additional Contributors

Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Florida Medical Association

Disclosure: Nothing to disclose.

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Diagram comparing clinical appearances of lesser-toe deformities.
Morton foot, wherein second ray (metatarsal and corresponding toe) is longer than first ray.
Pathomechanics of hammertoe deformity. Elongated plantar plate, caused by either metatarsophalangeal (MTP) synovitis and instability or chronic MTP hyperextension due to toe crowding, results in MTP subluxation or dislocation with compensatory proximal interphalangeal (PIP) flexion.
Painful dorsal callus over proximal interphalangeal (PIP) joint of second toe, caused by long-standing, fixed hammertoe deformity.
Physical examination maneuver to diagnose metatarsophalangeal (MTP) instability, wherein examiner attempts to translate proximal phalanx dorsally relative to metatarsal head. In most patients, subluxation is possible; therefore, this test is positive only when it causes pain.
Hammertoe shield for treatment of flexible hammertoe. Sling over proximal phalanx straightens toe, while shield under metatarsal head provides padding for painful callus that may be present, supports toe plantarly, and anchors sling.
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