The pathological anatomy of claw and hammer toes.

We sought to determine the optimum surgical treatment of claw and hammer toes (except for the hallux) on the basis of the specific pathological anatomy of each type of deformity. We dissected thirty-three fresh-frozen specimens that had been obtained from below-the-knee amputations. The specimens included ten normal feet, fourteen feet that had claw toes, six feet that had hammer toes, and three feet that had an uncategorized deformity. The contributions of abnormalities of the skin, tendons, joint capsule, and collateral ligaments to deformity of the metatarsophalangeal and proximal interphalangeal joints were determined by sequential sectioning of all of those soft-tissue components. Any alteration in the range of motion of the joints was recorded after each stage of the dissection. The findings of this study suggested that surgical correction of claw and hammer toes may necessitate more extensive sectioning of the soft tissues than had previously been believed.