Hammertoe is a deformity resulting from an abnormal bend of the of the middle joint of the second, third, fourth or fifth toes. The abnormal bending can put pressure on the toe when wearing shoes, which can cause problems.
Hammertoes can be a serious problem for anyone with diabetes or poor circulation, because this condition carries a higher risk of infection and foot ulcers. This condition usually begins as a mild deformity that becomes progressively worse over time. In the earlier stages, hammertoes are flexible and often respond to noninvasive measures. However, if left untreated, hammertoes can become more rigid over time and unresponsive to nonsurgical treatment.
Hammertoes can be excruciatingly painful, but there are many options available to ease the pain. Because of the progressive nature of this condition, you should seek medical attention as soon as possible – hammertoes never get better without medical intervention.
A hammertoe has an abnormal bend in the middle joint. The condition is most common in the second, third and fourth toes. The deformity occurs because of an imbalance in the muscles, tendons, or ligaments around the toe joint, which causes the middle joint of the toe to bend in an upside-down “V” position.
There are two types of hammertoes:
Flexible. This is an early and mild form of hammertoe. In this stage, the toe can still move at the joint, and there are more treatment options to correct the condition.
Rigid. Once the tendons in the toe become rigid, they press the joint out of alignment. At this stage, the toe cannot be moved, and surgery is the most likely treatment option.
What Causes Hammertoe?
The type of shoes worn, foot structure, trauma, and certain diseases can contribute to the development of hammertoe.
Shoes with higher heels force the foot down, confining the toes against the shoe, increasing the pressure and the bend in the toe. The toes rubbing against the shoe lead to the formation of corns and calluses, which further aggravate the condition. Eventually, the toe muscles become unable to straighten the toe.
One of the most common causes of hammertoe is an imbalance in the muscles, tendons, or ligaments due to mechanical (structural) or neurological changes in the foot, which lead to a bending of the toe. Muscles, for example, work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, one of the muscle pair tightens and does not allow the toe to stretch out.
Hammertoe can also develop as the result of:
Age. The risk of hammertoe increases with age.
Certain diseases. People who have arthritis or diabetes are more likely to develop foot problems, including hammertoe.
Genetics. Hammertoe can be hereditary and may run in some families.
Injury. When a toe is broken, stubbed, or jammed, hammertoe is more likely to develop.
Sex. Women are more likely to develop hammertoe than men because of the shoes they wear.
Toe length. If the second toe is longer than the big toe, hammertoe is more likely to occur.
Because some of the causes for hammertoe are avoidable, it is possible to minimize the risk of developing hammertoe.
What are the Symptoms of Hammertoe?
The symptoms of hammertoe are usually quite obvious. The middle joint of a toe will have an abnormal bend, and be in an upside-down “V” position that resembles a hammer. It may be difficult or painful to move the affected toe. Because of the toe rubbing against the inside of the shoe, the toe will develop a buildup of skin (corn or callus) on top of the middle joint or the tip of the toe.
People suffering from hammertoe may feel pain in their toes or feet, and have difficulty finding comfortable shoes to wear.
Other common symptoms of hammertoe can include:
The toe joint is difficult to move, and it hurts when attempting to move the joint.
The ball of the foot under the bent toe hurts.
Putting on a shoe hurts the top of the bent toe.
Pain or irritation of the affected toe when wearing shoes.
Inflammation, redness, or a burning sensation.
Inability to straighten the toe.
In severe cases, open sores may develop on the toe.
How is Hammertoe Diagnosed?
Although readily apparent, a proper diagnosis requires a physical exam by a doctor. The doctor will review a thorough medical history, in addition to examining the affected foot. During the exam, the doctor will study the shape of the toes, and will gently move the foot and toes to evaluate the condition of the affected toe.
In addition, an X-ray may be ordered to more closely examine the bone structure of the affected foot.
Hammertoes do not go away on their own (they are progressive). In most cases, hammertoes will get worse over time. However, not all cases are alike. Some instances of hammertoe will progress more rapidly than others.
How is Hammertoe Treated?
There are a variety of treatment options for hammertoe. The specific treatment depends on the severity of the hammertoe and other factors. If hammertoe is caught early enough, treatment can be accomplished with simple lifestyle changes and exercises. If conservative treatments do not work, surgery is an option.
If the hammertoe is still flexible, a doctor may recommend the following conservative treatments:
Change shoe wear. Wear good-fitting shoes; this does not necessarily mean expensive shoes. Avoid shoes with pointed toes, shoes that are too short, shoes with high heels, and walking conditions that force the toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches. Always wear the appropriate shoes for the activity.
Exercises. Foot exercises can help restore muscle balance. The doctor may prescribe picking up marbles with the toe or crumpling a towel with the toes to help stretch and strengthen toe muscles.
Splinting. Immobilizing the toe may help in the very early stages of hammertoe.
Ice Pack. Placing an ice pack on the hammertoe will help reduce painful swelling.
Massage. A gentle self-massaging of the toe can help relieve pain.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help with pain management and inflammation.
Orthotic devices. A custom orthotic device worn in the shoe may help control the muscle/tendon/ligament imbalance, reduce pain, and stop the hammertoe from worsening.
Injection therapy. Corticosteroid injections are sometimes helpful in easing pain and inflammation of hammertoe.
Padding corns and calluses. Specially designed pads available over-the-counter or by prescription can shield corns and calluses from irritation. Avoid medicated over-the-counter pads, because they may contain a small amount of acid that can be harmful. Non-medicated hammertoe pads are available that fit around the top of the toe joint and help relieve painful pressure. Some have a gel lining to help prevent irritation of the toe by the shoe.
Hammertoe patients with diabetes, poor circulation, or a lack of feeling in the feet, should talk to their doctor before attempting any self-treatment.
If conservative treatments fail, surgery is an option in cases where the hammertoe has become more rigid and painful, or if an open sore exists. Surgical options include repositioning the toe, realigning tendons, and the removal of deformed or injured bone. The surgical procedures include:
Arthroplasty. Removal of half of the joint under the crooked part of the toe to help the toe straighten.
Arthrodesis. Similar to arthroplasty, but the entire joint is removed, and a wire or pin is inserted to help healing.
Tendon transfer. Tendons from under the toe are rerouted to above the toe to aid in straightening the toe. This may be done in conjunction with other surgical interventions.
Basal phalangectomy. The base of the bone underneath the toe is removed, which is an option for patients with severe stiffness.
Weil osteotomy. The metatarsal bone is shortened, and surgical hardware is inserted to aid healing. Splints or small straps may be applied by the surgeon to realign the bent toe.
Often, patients with hammertoe have bunions or other foot deformities corrected at the same time. The length of the recovery varies, depending on the surgery.
It is possible for hammertoe to return after surgery. If this happens, additional surgery may be necessary to address the pain.
Is It Possible to Prevent Hammertoe?
Hammertoe is not only treatable, it is preventable. The best way to make sure hammertoe does not occur is by choosing proper footwear and taking care of the feet.
Check feet regularly for problems, especially if you have diabetes, or any other medical condition that causes poor circulation or numbness in the toes.
Good circulation is essential to avoiding hammertoe. When sitting, put your feet up. After sitting for a while, get up and stretch the legs and feet. Give yourself a foot massage or warm foot bath.
It is possible to avoid many foot, heel, and ankle problems with correctly fitting shoes. Here are some tips for buying shoes:
Adequate toe room. Avoid shoes with pointed toes.
Adjustability. Shoes with adjustable laces and straps are best.
Avoid multiple shoe pieces. Avoid shoes with a lot of stitching or multiple pieces of fabric, especially in areas of the foot having medical conditions, since stitched areas tend not to stretch to accommodate toe deformities.
Buy shoes at the end of the day. Feet swell throughout the day, so you will get the best sense of fit at the end of the day.
Buy shoes that fit. Be sure shoes are comfortable before purchasing them. It may be possible to stretch shoes, but it’s best to buy them to fit. As we age, shoe sizes tend to change, especially the width. Measure both feet, and buy a pair of shoes fitted for the larger foot. Make sure the ball of the foot fits into the widest part of the shoe. Also, don’t rely on advertised shoe sizes alone, since shoe sizes vary among manufacturers. A shoe is the right size only when it fits comfortably.
Enough toe room. Shoes should be appropriately sized. Shoes should be large enough to accommodate the longest toe, which may not always be the big toe.
Leave room. There should be at least one-half inch between the tip of the longest toe and the front of the shoe.
Low heels. Higher heels force the feet into unnatural positions and often bend the toes. The higher the heel, the less safe the shoe. Avoiding high heels will help prevent back problems and toe deformities.
No slipping. Shoes should not ride up and down on the heel when walking.
Proper arch support. Avoid many foot ailments by getting shoes with a good arch support.
Sturdy shoes. A shoe should be sturdy such that it only bends in the ball of the foot, exactly where the big toes bend. Any shoe that can be bent anywhere along the sole or twisted side to side is generally too flimsy.
Different size feet. Most people have one foot that’s bigger than the other. Fit shoes to the larger foot.
Wear appropriate socks. When buying shoes, wear socks that will be worn with the shoes. For example, wear an athletic sock when buying athletic shoes, and a dress sock when purchasing dress shoes. If the shoes do not feel good at the time of purchase, then they will never feel good.
Children’s shoes. Check children’s shoes often to make sure they still fit.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating hammertoe pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.