Claw toe is another similar condition, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint , combined with flexion of both the proximal and distal interphalangeal joints. Assess MTP hyperextension, plantar displacement of the metatarsal heads and distal migration of the fat pad. Drill the pin retrograde from the middle phalanx out of the tip of the toe. After the pin has been drilled back into the proximal phalanx and metatarsal head, repair the skin and extensor tendon over the proximal interphalangeal joint. Bent pin at the end of the toe; the proximal incision has been used for Z lengthening of the extensor tendon. Drill the wire out of the tip of the toe, then back through the proximal phalanx and metatarsal head. Toe in straightened position, with a dorsal incision used to expose the dorsal metatarsophalangeal capsule for release. The toe is pinned with a 0.54-mm Kirschner wire just prior to transferring the tendon dorsally (not shown in movie). Patient compliance is particularly important in the treatment of these conditions. Ignoring the symptoms of deformities of the toes can aggravate these conditions and lead to a breakdown of tissue, or even infection. If surgery is recommended, it is important to fully understand and follow the recommendations of the surgeon before and after the procedure. If treatment does not heel your toe, you may require surgery. Extensor tenotomies may not have the desired outcome and a multitissue approach may be warranted, an observation that is supported by the work in nondiabetic feet from Myerson and Shereff ( 7 ), who suggested that the correction of claw toes may require more extensive sectioning than formerly believed. However, x-rays are usually taken to view the bony structures of the toe and to clearly see which joints are contracted. If these calluses are exposed to constant excessive pressure-for example, the toe is continuously rubbing against the top of the shoe then there is a risk for the skin to break open causing a small ulcer. Aching pain in the toe, which is worse with walking or after standing for long periods of time. Bunions-the big toe may be crossing over into the second toe's area causing it to have to curl” over the big toe. Orthotics help slow the progression because the goal of orthotics is to provide a properly functioning foot. If you have a flat foot, you should use shoe inserts that will assist the foot muscles to work together. Keep in mind its causes, and watch out for its symptoms, so that it is detected at an early stage and causes you less trouble. It is not intended to be a substitute for the advice of a medical expert. Hammertoes may also result from wearing high heels. The most effective treatment for Diabetic Foot is surgery, where any deformities in the toes are corrected. On the other hand, there are patients who seek hammer toe treatment without surgery to avoid being unable to move around for a few days and also so as not to spend money. Buy shoes that have a large enough gap in the toe box to give more space whilst walking. Crest pads for hammer toe help soothe tired feet and toes after a long day on your feet. In: Jahss M, ed. Disorders of the Foot and Ankle.