A Hammer toe
is a toe that is bent because of a muscle imbalance around the toe joints.
The imbalance causes the toe to bend at one or more joints, pushing the middle of the toe upward in a claw-like position. If you notice such changes, it is important to seek proper treatment. Hammer
toes never get better without some type of intervention and the sooner it is treated, the better the outcome.
Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot.
Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problem
(e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid
arthritis, stroke, Charcot-Marie-Tooth disease, complex regional pain syndrome or diabetes.
Hammer toe can also be found in Friedreich's ataxia.
The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward. Thickening of the skin above
or below the affected toe with the formation of corns or calluses. Difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any
symptoms except for the claw-like toe shape.
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear
crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at
the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still
flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the
involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer
toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. Other conservative treatments include using forefoot products
designed to relieve hammer toes, such as hammer toe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe
caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.
Joint resection procedures involves removing part of one of the two small joints of the toe directly underneath where the digit is crooked. The purpose is to make room for the toe to be re-positioned
flat or straight. Because hammer toes become rigid or fixed with time, removing the joint becomes the only option when the knuckle is stiff. Its important to understand that this procedure does not
involve the joint of the ball of the foot, rather the a small joint of the toe. Medical terminology for this procedure is called a proximal interphalangeal joint arthroplasty or a distal
interphalangeal joint arthroplasty, with the latter involving the joint closer to the tip of the toe.