Initial treatment consists of shoes with a soft, deep, and wide toe box. Patients should avoid tight or narrow shoes, such as high heels. A shoe repair shop may be able to stretch the toe box of certain shoes to provide relief of irritation to the toes. A custom orthotic in the shoe is also helpful to control the muscle/tendon imbalance.
A Budin splint or crest pad can be used to shield the hammertoe and force the muscles of the toe to stretch. In addition, over-the-counter pads may be placed over the corns to reduce the amount of irritation.
Injection of corticosteroids or nonsteroidal anti-inflammatory medications may reduce swelling and pain.
Surgery is recommended in persons whose condition has progressed or who have gotten no pain relief from conservative treatment. The type of surgical treatment depends on the severity of the deformity.
A flexor tenotomy can be considered for a reducible hammertoe in an elderly or medically compromised patient. It provides a minimal incisional approach with minimal postoperative recovery.
A PIP joint arthroplasty can be considered for a semi-reducible or rigid deformity of the PIP joint. This procedure provides correction of the deformity by shortening the phalanx.
Arthrodesis (fusion) of the PIP joint should be considered for a semi-rigid or rigid deformity of the PIP joint. It is the procedure of choice when there is an associated neurologic dysfunction.