The digits of the foot are identified as first or great toe, second, third, fourth, and fifth. Each digit (except the great toe) includes three phalanges: proximal phalanx (closest to the ankle), middle phalanx, and distal phalanx (closest to the tip of the toe).  Hammer toe is a condition in which the first proximal phalanx of a toe is hyperextended or dorsiflexed, and the 2nd (middle) and 3rd toe (distal phalanx) bones hyperextend with or without hyperextension at the metatarsophalangeal (MTP) joint. 

The causes of the condition may be congenital, or acquired due to environmental stress such as prolonged pressure from short, narrow-toed shoes. Acquired hammer toe is usually bilateral.

The metatarsophalangeal and interphalangeal joints may be flexible or fixed. Other manifestations may include: pain; callosities; ulcers or skin breakdown; deformity; and reduced joint mobility.

Diagnostic measures include x-rays, a comprehensive history, and physical examination.

Treatment depends on the severity of the deformity, and may include: splinting; shoe inserts; protective padding; corrective-footwear; arch support; and surgery.

Residuals may include: pain; deformity; a lateral drifting of the great toe which pushes the second toe laterally; reduced joint mobility; and change in gait.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• When multiple foot disabilities are present, but the etiology of the symptoms cannot be separated, assign a single disability evaluation for the predominant symptoms. If the etiology of the symptoms can be delineated, separate disability evaluation may be assigned under multiple DCs for foot disabilities provided that the principles of 38 CFR 4.14 have not been violated.

• None.