Hammertoe Deformity Clinical Presentation

Updated: Jan 29, 2021
  • Author: Anthony Watson, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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Presentation

History

A patient with symptomatic hammertoe typically complains of pain over the dorsal aspect of the proximal interphalangeal (PIP) joint of the affected toe. Occasionally, the patient also complains of pain over the plantar area of the metatarsal head, especially if the metatarsophalangeal (MTP) joint is hyperextended, subluxated, or dislocated.

A callus may be present over the dorsal surface of the PIP joint, over the plantar surface of the metatarsal head, or at the tip of the toe (see the image below). In addition, patients with MTP joint instability often complain of pain over the dorsal part of the MTP joint, and they may describe the sensation of a lump in the plantar area of the MTP joint.

Painful dorsal callus over proximal interphalangea Painful dorsal callus over proximal interphalangeal (PIP) joint of second toe, caused by long-standing, fixed hammertoe deformity.
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Physical Examination

The physical examination of hammertoe deformity must include the following:

  • Neurovascular evaluation, including palpation of pulses
  • Sensory examination, with emphasis on protective sensation
  • Evaluation of intrinsic muscle bulk
  • Assessment of flexibility (is the deformity flexible or rigid?)

The deformity should be assessed while the patient is standing so that its functional significance can be better appreciated. Accompanying deformities, such as hallux valgus, combined hammertoe and rotational deformity, and cavus foot deformity, must be catalogued. Passive correction of the deformity should be attempted because this will help determine which treatment options are appropriate for the patient.

Palpate both the plantar and articular portions of the metatarsal head, because patients with MTP instability have greater tenderness of the articular portion and may require treatment different from that of patients with isolated hammertoe. Pain with dorsal subluxation of the MTP joint implicates MTP instability (see the image below). Palpate the webspace, and compress the forefoot by squeezing the metatarsals together from medial to lateral. These two maneuvers help exclude an interdigital neuroma, which often is confused with MTP instability.

Physical examination maneuver to diagnose metatars 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.
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