The four middle phalanges of the toes (absent in the great toe) provide the connection between the proximal and distal phalanges, and are the primary site of hammer toe deformity when the flexor tendons become chronically contracted.
Middle foot phalanges are present in toes 2 through 5 only (the great toe lacks a middle phalanx). Hammer toe deformity produces fixed PIP flexion contracture of the middle phalanx on the proximal phalanx, causing painful dorsal pressure at the PIP joint from shoe friction. Surgical correction involves resection arthroplasty or arthrodesis of the PIP joint.
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