# Hammer toe - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Hammertoe - StatPearls - NCBI Bookshelf (NBK559268) - https://www.ncbi.nlm.nih.gov/books/NBK559268/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD71.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text HAMMER TOE Sources: Hammertoe - StatPearls - NCBI Bookshelf (NBK559268) - https://www.ncbi.nlm.nih.gov/books/NBK559268/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD71.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - A slowly worsening bend at the middle joint of the toe, which turns red and sore - Long-standing pain that is worse on walking and in shoes, and grows as the deformity progresses [visible deformity] - Some feel the pain under the ball of the foot, which goes with the toe joint riding up, slipping or dislocating SIGNS - what you find (8) - Pressure damage on the skin: blisters, callus, ulcers or soreness over the top of the middle joint, under the ball of the foot, or at the toe tip [blisters] - The bend is at the middle joint, with the end joint straight or slightly extended, and the big toe joint may or may not ride up - It is usually a lone toe, most often the second - Look with the patient standing as well as sitting, because some deformities only show under load - A flexible toe deforms on standing and straightens when the ankle is placed passively in neutral; a rigid one stays bent - The Lachman test checks stability of the joint at the base of the toe, and the flexibility of each deformity is recorded [visible deformity] - Extra tenderness or looseness over the joint surface of the metatarsal head points to a second problem beyond the bent toe - Foot mechanics feed the deformity, and hallux valgus often sits alongside it [visible deformity] TESTS (5) - Standing AP, oblique and lateral foot films are the mainstay, showing joint contracture and the gun barrel appearance of the proximal phalanx canal - Films also compare metatarsal lengths and pick up hallux valgus and metatarsus adductus from overall forefoot alignment - Draw a line across the tips of the neighbouring toes; if the affected toe crosses it, the toe is too long - MRI is for suspected plantar plate rupture or other soft tissue and bone problems, and shows dead bone in the metatarsal head, usually the second, plus cartilage defects - With diabetes, peripheral neuropathy or vascular disease, non-invasive arterial studies gauge blood supply and healing IF NOT THIS - what else fits (9) - Claw toe: both toe joints bent with the joint at the base pulled up - Claw toe is generally worse, hits several toes on both feet, goes with neuromuscular disease, and sits on a high-arched foot - Mallet toe, where only the end joint is bent - Turf toe - Sesamoiditis or gout - Osteochondrotic lesion of the first metatarsal head - Osteochondritis dissecans - Metatarsalgia - Metatarsal stress fracture Source StatPearls "Hammertoe" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult A bent, fixed deformity of a toe joint; managed with footwear modification, toe padding, and analgesia, with surgical referral if severe or if the deformity ulcerates. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why A bent, fixed deformity of a toe joint; managed with footwear modification, toe padding, and analgesia, with surgical referral if severe or if the deformity ulcerates. Caution Skin ulceration or infection over the deformity, particularly in patients with diabetes or peripheral vascular disease. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)