Hammertoe Correction Michigan 2026 | Podiatrist

Hammer toe deformity is caused by an imbalance between the extrinsic and intrinsic foot muscles that flex and extend the lesser toes -- the imbalance flexes the proximal interphalangeal joint (PIPJ) while the metatarsophalangeal joint (MTPJ) remains neutral or extends; over time, the capsule and periarticular soft tissues contract, converting a flexible deformity into a rigid one. The muscle balance of the lesser toes: normally, the long flexors (FDL -- flexes the DIP joint) and extensors (EDL -- extends the MTP joint) are balanced by the intrinsic muscles (lumbricales and interossei); the intrinsic muscles run plantar to the MTPJ axis and dorsal to the PIPJ axis, providing both MTP plantar flexion and PIP extension -- a crucial dual function; when the intrinsics weaken or the extrinsics overpower them, the EDL hyperextends the MTPJ and the FDL flexes the PIPJ unopposed; the resulting posture is hammer toe; Causes: narrow shoes: the most common cause; a toe box too narrow for the foot forces the toes into a flexed, crowded position; the toes adapt to the constrained position; high heels: simultaneously drive the foot forward into the narrow toe box and plantarflex the MTPJ, increasing EDL tension on the PIPJ; intrinsic muscle weakness: as part of normal aging; peripheral neuropathy (diabetic, Charcot-Marie-Tooth) specifically destroys the intrinsic motor neurons; the intrinsics are the smallest muscles supplied by the most terminal nerve branches -- they are preferentially lost in neuropathy; neuromuscular diseases: CMT, cerebral palsy, Friedreich's ataxia; second toe longer than the great toe (Morton's foot): the long second toe is forced into the shoe toe box in a flexed position; flatfoot and bunion deformity: a bunion displaces the great toe laterally, crowding the second toe and forcing it into a hammer position; Why hammer toes become rigid: initially, the PIPJ contracture is flexible -- passive correction to neutral is possible; as the deformity persists, the joint capsule, collateral ligaments, and periarticular soft tissues contract into a fixed shortened position; the cartilage may erode at the flexed position; by the time the toe has been flexed for years, the PIPJ is a fixed rigid contracture that cannot be passively straightened; rigid hammer toes require bony surgery to correct; flexible ones may respond to splinting and physical therapy.

Hammer toe surgery is recommended when the deformity causes persistent pain, corn formation, difficulty with footwear, or functional limitation that fails to respond to conservative management -- the surgical procedure varies based on whether the deformity is flexible or rigid and the degree of MTPJ involvement. Conservative treatment (always first): footwear modification: a wide, deep toe box shoe eliminates dorsal shoe pressure on the PIPJ; seamless uppers avoid friction points; gel tube sleeves over the toe protect the corn from shoe contact; professional corn debridement provides immediate temporary relief; hammer toe splints and toe aligners: for flexible hammer toes, a splint passively holds the toe in a straightened position; most effective when started early while the deformity is flexible; metatarsal pads: for concurrent metatarsalgia from the MTPJ subluxation; physical therapy: intrinsic strengthening exercises (towel scrunching, marble pickup, toe spreads); taping; Indications for surgery: persistent PIPJ pain from the dorsal corn despite optimal footwear; the toe cannot fit in any shoe comfortably; ulceration on the dorsal PIPJ (in diabetic patients -- urgent); concurrent dislocation of the MTPJ; significant functional limitation; Surgical procedures for hammer toes: PIPJ arthroplasty (resection arthroplasty -- the most commonly performed procedure): the head of the proximal phalanx is resected (removed); the resulting space allows the toe to straighten; the toe retains some limited mobility at the resected joint level; a K-wire holds the corrected position for 3-4 weeks then is removed in the office; PIPJ arthrodesis (fusion -- more permanent correction): the articular surfaces of the PIPJ are removed and the joint is fused in a straight position; fixation options: K-wire (temporary, removed at 4-6 weeks), intramedullary device (Smart Toe implant, ProToe -- permanent), titanium screws; provides the most durable correction; eliminates the small risk of recurrence that exists with arthroplasty; MTPJ release (when the MTPJ is involved): for hammer toes with concurrent MTPJ subluxation or dislocation; extensor tendon lengthening (Z-tenotomy) and MTPJ capsule release allow the MTPJ to reduce; Weil osteotomy (shortening metatarsal osteotomy): for dislocated MTPs; shortens the metatarsal to allow reduction; Recovery: weight-bearing in a surgical shoe from day 1; K-wire removal at 3-4 weeks; transition to regular wide shoes at 4-6 weeks; final result at 3 months.