Hammertoes

The lesser toes (the four lateral to the great toe) have a less important role in walking than the more dominant big toe. Gait studies reveal that 75-80% of push-off pressure comes through the great toe. However, the other four still have to fit within our shoes, and hopefully not complain of any discomfort. Just like the fingers on our hands, there are multiple muscles attached through tendons to each toe. When there is some outside force exerted on one or more of these smaller digits, pain and deformity may result. The root cause may be an ill-fitting toebox, a bunion deformity creating pressure against the adjacent second toe, or a change in normal gait pattern caused by something going on elsewhere in the body, producing an imbalance in the normally balanced pull of the aforementioned tendons. The toe may cock up at the base, buckle downward in the middle or at the end, or deviate to one side or the other. If painful symptoms cannot be improved by changing the shape or depth of the shoe’s toebox, surgical intervention may become necessary. If the deformities have been present for a long time, contractures may develop, meaning that even with firm manual pressure, the deformity cannot be corrected back to normal alignment. In such cases, the surgery must resect a short length of bone, release of soft tissue contractures alone often will not suffice.