Overview
What is a hammertoe deformity?
How is hammertoe deformity treated nonoperatively?
What are the surgical treatments for hammertoe deformity?
What is the anatomy of the phalanges relevant to hammertoe deformity?
What is the pathophysiology of hammertoe deformity?
What causes hammertoe deformity?
What is the prevalence of hammertoe deformity?
What is the prognosis of hammertoe deformity?
Presentation
Which clinical history findings are characteristic of hammertoe deformity?
What is included in the physical exam to evaluate a hammertoe deformity?
Which physical findings are characteristic of hammertoe deformity?
DDX
Which conditions are included in the differential diagnoses of hammertoe deformity?
Workup
What is the role of lab tests in the workup of hammertoe deformity?
What is the role of imaging studies in the workup of hammertoe deformity?
What is the role of histology in the workup of hammertoe deformity?
Treatment
How is a hammertoe deformity treated?
Which medical therapies are used in the treatment of hammertoe deformity?
What is the role of surgery in the treatment of hammertoe deformity?
What is involved in preparation for surgical treatment of a hammertoe deformity?
What is the role of flexor tenotomy in the treatment of a hammertoe deformity?
What is included in postoperative care following surgery for hammertoe deformity?
What are the possible complications of hammertoe correction surgery?
What is included in the long-term monitoring of a hammertoe deformity?
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Diagram comparing clinical appearances of lesser-toe deformities.
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Morton foot, wherein second ray (metatarsal and corresponding toe) is longer than first ray.
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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.
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Painful dorsal callus over proximal interphalangeal (PIP) joint of second toe, caused by long-standing, fixed hammertoe deformity.
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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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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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Severe hammertoe deformity in second toe overlapping great toe with associated hallux valgus deformity.
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Anteroposterior radiograph showing hammertoe deformity in second toe and associated hallux valgus deformity in forefoot.
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Lateral radiograph showing hammertoe deformity.
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Intraoperative fluoroscopic image showing correction of deformities in first and second rays and use of Kirschner wires to stabilize osteotomies.
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Anteroposterior radiograph at 3-month follow-up showing correction of hammertoe and hallux valgus deformities.
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Lateral radiograph at 3-month follow-up showing correction of lesser-toe deformity.
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Clinical photograph showing correction of deformities involving second and great toes.
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"Sausage toe" complication occurring after Girdlestone-Taylor tendon transfer.