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Hammer ToeOverview
A Hammer toes 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.

Causes
Footwear is actually the leading cause of this type of toe deformity so much so that people sometimes require hammer toe surgery to undo some of the damage. The most common problem is wearing shoes that are too short, too narrow or too tight. These shoes constricts the feet and force the toes into a bend position. Women are more at risk especially due to high heels. Footwear isn?t the only problem, poor foot posture can lead to muscle and even bone imbalances. This asymmetry can cause excessive strain on the toes either by forcing the toe into unnatural positions. Arthritis can also play a factor in the development of hammer toe, especially if the toe joint is stiff and incapable of a full range of motion.Hammer Toe

Symptoms
The most obvious symptoms of this injury will be the the middle toe joint is permanently bent at an angle. In the beginning movement may still be possible but as time passes and the injury worsens the toe will be locked in place and possible require hammer toe correction surgery to fix. Another key indicator of hammer toe is that a lump or corn will form on top of the toe. The toe joint will be painful and walking can cause severe discomfort. Occasionally a callus may form on the sole of the injured foot. If you see any of these symptoms together or have been enduring pain for some time, seeing a podiatrist should be your next step.

Diagnosis
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
You should seek medical advice if you have a hammer toe. Here are some things you can do in the meantime. None of these things will cure the hammer toe, but they may relieve the pain and discomfort. Only wear shoes that are high and broad across the toes. There should be at least 1.5 cm of space between your longest toe and the tip of the shoe. Keep in mind that this could be either your big toe or your second toe. Don't wear heels higher than 5 cm. Wear the appropriate shoe for the activity you are doing. You can buy non-medicated hammer toe pads. They fit around the pointy top of the toe joint and help relieve painful pressure. Gently massaging the toe may help relieve pain. Put ice packs wrapped in cloth on the hammer toe to reduce painful swelling.

Surgical Treatment
Surgical correction is necessary in more severe cases and may consist of removing a bone spur (exostectomy) removing the enlarged bone and straightening the toe (arthroplasty), sometimes with internal fixation using a pin to realign the toe; shortening a long metatarsal bone (osteotomy) fusing the toe joint and then straightening the toe (arthrodesis) or simple tendon lengthening and capsule release in milder, flexible hammertoes (tenotomy and capsulotomy). The procedure chosen depends in part on how flexible the hammertoe is.
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