Hallux Malleus "hammer toe"- Symptoms, surgical and nonsurgical treatment

What is a hallux hammertoe?

A hallux hammertoe is when the big toe is flexed. This may occur alone or with hammertoes of the other digits. This is also known as hallux malleus. 
Note: 
  • Hallux for the big toe 
  • Malleus for a hammer 
Hallux malleus is a deformity of the great toe. This deformity can be very stiff or flexible. The joint in the great toe becomes contracted in a flexed or downward position. 

 

This deformity usually occurs due to an imbalance of the tendons that insert on the top and the bottom of the great toe. When the tendon on the bottom of the toe (the tendon that causes the toe to flex down) over powers the tendon that causes the toe to bend up, this deformity occurs. 

Usually patients will develop a callus and even an ulcer on the tip of the great toe. This deformity is often seen in conjunction with hammer toes. High arched feet are typically the most affected by this deformity.

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This deformity is treat initially with padding techniques to prevent sores from developing at the tip of the toe. Custom, soft, accommodative orthoses are sometimes prescribed for the patient to provide cushioning and also to prevent worsening of the deformity.
If conservative treatment fails, surgery is indicated. Surgery usually consists of performing a bone fusion of the 2 bones in the great toe. This can be done with screws, staples, or wire fixation.

Symptoms of Hallux Malleus "hammer toe"?

People with a hallux hammertoe may have irritation at the top of the big toe joint or at the tip of the toe if the deformity is severe. People with neuropathy or diabetes may even develop a wound at either location.

What is the nonsurgical treatment for a hallux hammertoe?

Conservative treatments consist of padding the big toe and wearing shoes with a wide, stretchy toe box to avoid irritation.

What about hallux hammertoe surgery? 

If the hallux hammertoe is flexible, a simple tendon release may be recommended. If the deformity is rigid, either a joint fusion or joint resection (arthroplasty) may be performed to straighten the big toe. The type of the procedure recommended largely depends on the patient activity level and any associated health problems.

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Usually after the procedure, weightbearing in a removable cast boot is permitted and the duration is up to around 6 weeks in the case of a joint fusion.

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