Management of Hammer Toe in Diabetic Patients

Conservative Management

The American Diabetes Association recommends starting with conservative management in all patients, but proceeding directly to digital flexor tenotomy when conservative treatment fails in diabetic patients with hammertoes and pre-ulcerative signs or distal toe ulcers 1
Prescribe extra-depth shoes with wide toe-box and soft uppers to accommodate the deformity and reduce pressure on bony prominences, with a shoe length 1-2 cm longer than the foot and internal width equal to the foot width at the metatarsophalangeal joints 2, 3
Consider custom-made insoles or toe orthoses when foot deformity or pre-ulcerative signs are present, to redistribute pressure and reduce mechanical stress 1, 2
Provide regular professional treatment for callus removal, nail care, and pre-ulcerative lesions every 1-3 months for high-risk diabetic patients, and instruct patients to inspect feet daily and wear properly fitting footwear 1, 2, 3

Digital flexor tenotomy is the preferred surgical intervention for diabetic patients with flexible hammertoes and pre-ulcerative signs or distal toe ulcers, with healing rates of 92-100% achieved in mean 21-40 days and low complication rates 2
This procedure can be performed as an outpatient procedure without subsequent immobilization, and has recurrence rates of 0-20% over 11-36 months follow-up 2

Hammertoes in diabetic patients with neuropathy or peripheral artery disease are considered pre-ulcerative lesions requiring immediate intervention, and should be assessed for loss of protective sensation using 10g Semmes-Weinstein monofilament and checked for pedal pulses 1, 2, 3
Provide integrated foot care every 1-3 months including professional foot treatment, therapeutic footwear, and education, to prevent ulcer development in diabetic patients with neuropathy or peripheral artery disease 1, 2
Post-operative infection risk is 9.5% in diabetic neuropathy patients, requiring careful patient selection, and high mortality rate in this population emphasizes importance of prevention 2