OverviewHammer toes is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammer toes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammer toes can become more rigid and will not respond to non-surgical treatment. Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
Causes
Wearing ill-fitting shoes is probably the main cause of hammer toe. As the toe bends, tendons add to the problem by contracting in such a way that the bending is reinforced to the point of becoming permanent. In some cases, tendons that are abnormal to begin with may start the bending process.
Symptoms
Hammer toes can cause problems with walking and lead to other foot problems, such as blisters, calluses, and sores. Pain is caused by constant friction over the top of the toe?s main joint. It may be difficult to fit into some shoe gear due to the extra space required for the deformed toe. In many cases there will be pain on the ball of the foot over the metatarsals along with callus formation. This is due to the toes not functioning properly, failing to properly touch the ground during the gait cycle. The ball of the foot then takes the brunt of the ground forces, which causes chronic pain.
Diagnosis
The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.
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.
Surgical Treatment
Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.
Prevention
To prevent a hammertoe, never squeeze your toes into shoes that force them to bend unnaturally. Those tendons can tighten up, and leave a permanent, claw-like bend in your toe. Always slip your feet into soft, roomy shoes that easily accommodate all of your toes. Stretching your toes can also help keep the tendons in the toes relaxed, and prevent a hammertoe. Use your hands to gently straighten and stretch your toes or try to pick up objects with your toes, grabbing something from the floor, for example. Sitting on a blanket and using your toes to grab the ends with also relax your feet.