Aim of the study. To study clinical and radiological features of hammertoe deformity of the middle toes, accompanied by overload (primary) metatarsalgia.
The results of clinical and radiological examination of hammertoe deformity of 227 toes on 127 feet in 103 patients (96 women and 7 men) aged 31 to 79 years were studied. During clinical examination, the degree of transverse flatfoot and the variant of the 2nd, the 3rd, and the 4th hammertoe deformity were determined, the passive range of motion in the metatarsophalangeal (MTP) joints was measured, the Visual Analogue Scale (VAS) for pain and the American Orthopаedic Foot and Ankle Society Lesser Toe Scale (AOFAS-II-V) were used. X-ray evaluation determined the angular parameters of the forefoot and evaluated the ratio of the lengths of the metatarsals. The analysis showed that the deformity of the 2nd toe was noted in 54.62% of cases, the 3rd – in 32.16%, and the 4th – in 13.22% of cases. At the same time, the extensor variant of hammertoe deformity was observed in 29.9% of cases, the flexion variant – in 31.5%, and the extensor-flexion variant – in 38.6% of cases. X-ray showed a significant increase in the median values of the valgus angles of the 1st, the 2nd, the 3rd, and the 4th toes, as well as a significant excess of the length of the 2nd metatarsal over the 1st one. The median value of VAS reached 6 [6; 7] points, and the median AOFAS-II-V was only 35 [30; 47] points, while the state of the feet in 80.31% of cases was assessed as unsatisfactory. Thus, the deformity of the middle toes, complicated by overload metatarsalgia, is characterized by the prevalence of the most severe extensor-flexion variant of the hammertoe deformity, accompanied by an excessive length of the 2nd and the 3rd metatarsals, which leads to widespread corns on the sole and severe pain in the forefoot.

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