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What Exactly Is a Hammertoe?
A hammertoe is when a toe is bent. It can occur in any toe. There are two bones in your great toe with one joint.
There are two joints in your second through fifth toes. When toes 2-5 are bent, it is called a “hammertoe”.
Hammertoes can cause significant problems in patients who suffer from them. Your toes are important and needed for balance when walking (1). Severe hammertoes can lead to painful corns, ulcerations, and pain due to irritation against shoe gear.
Most people may notice that their toes slowly bend when younger, and continue to worsen over the years.
So let’s dive in to discuss the 7 main causes of hammertoes….
1) Your Genetics Can Cause Hammertoes
Hammertoes are often genetic. Hammertoes can happen due to muscle and tendon imbalance in the foot. Certain tendons in your toes will overpower the weak muscles in your foot causing the toes to bend over time.
If one of your parents had hammertoes, there is a higher chance that you may develop hammertoes too.
2) Neuromuscular Disorders Can Cause Hammertoes
Certain neuromuscular disorders can make you more prone to developing hammertoes. For example, if you suffer from Charcot-Marie-Tooth disease, you may have some muscle and tendon imbalance in your foot.
In people who suffer from Charcot-Marie-Tooth disease, a high-arched foot and hammertoes may be visible.
3) Shoe gear
There are so many instances where people wear shoes that are too small for their feet. Wearing shoes that are too cramped or narrow can cause tendon imbalance over time, which can cause hammertoes to form.
In fact, because of shoe gear, women are more likely to develop hammertoes than men.
Wearing certain shoes (like high heels) can cause the toes to stay bent. Not only is the toe box of most high-heel shoes narrow, but the heel height itself pushes your foot forward so your toes hit the edge of your shoe. This causes the toes to bend further.
Although shoe gear is not a direct cause of a hammertoe, it can certainly make the condition worse.
Find out more about how Bad Shoes Can Affect the Feet in this supplemental article.
4) Trauma Can Cause Hammertoes
Injuries can do damage to the bones, ligaments, and tendons in your toes. This can cause deviation of your toes.
For instance, if you break the same toe many times, your toe bones may become misaligned overtime due to damage. Repetitive fractures can cause shortening of the toe bones.
If you tear tendons and ligaments in your toe that are responsible for keeping your toes straight, you may notice a gradual drift or bending of your toe.
5) Age
Although being a certain age doesn’t cause a hammertoe, hammertoes do worsen with age.
With chronic instability in the foot and improper footgear, hammertoes can progress and cause problems.
Say for instance you wore flat shoes your whole life, and you have a family history of hammertoes, you may start to notice that your hammertoes have worsened quickly over the years.
6) Arthritic conditions
If you have arthritis (especially Rheumatoid arthritis or Psoriatic arthritis) you may be more prone to developing hammertoes.
Arthritis can directly affect the joints in the toes. It can destroy the toe joints, causing the bones to drift and cause a hammertoe to form.
Read more about How to Manage Foot Arthritis.
7) Conditions That Cause Nerve Damage in the Feet
Certain conditions that can cause nerve damage in the feet including diabetes, excessive alcohol use, and stroke can cause hammertoes to form.
When there is nerve damage, it can affect the muscles and weaken them. This imbalance can cause the toes to bend.
Read the Ultimate Guide To Nerve Pain On the Foot.
How Are Hammertoes Diagnosed?
Your doctor will be able to tell if you have a hammertoe by doing a physical exam. He/she will order x-rays to adequately assess the bones in your toes.
Your doctor will also want to check if your hammertoe is:
- Flexible
- Semi-rigid
- Rigid
This is especially important for surgical planning. Stiff rigid toes respond differently to certain surgeries compared to toes that are more flexible.
What are Non-Surgical options for Hammertoes?
Shoes with a deep toe box
If you have severe hammertoes, make sure to only buy shoes with a deep toe box so that the top of the shoe doesn’t rub on the toes and cause a blister or corn to form.
Corns can develop due to the buckling effect of your toe (2), and can be painful. If corns are not addressed, sometimes it can progress to an open sore (ulcer).
Another alternative would be to buy athletic shoes that have a toe box that is soft. Mesh toe boxes work well. A lot of running shoes nowadays are made this way to allow for less irritation in the toes.
Padding
You can obtain pads that protect your toes from blisters, corns, and ulcerations. There are a variety of hammertoe pads including corn pads, crest pads, and gel spacers that you an wear to protect your toes.
Here are a list of my favorite pads…
If you have hammertoes that rub against each other you can obtain foam toe spacers. Here’s an example picture on how to wear them.
Some people prefer gel toe spacers because of a smoother consistency. This can work well to separate the toes as well.
If you have corns on the top of your toes or in between your toes, you can obtain Dr. Jill’s digital corn pads. These pads are great because they are adhesive, and can be applied on the top of your toes or between your toes to prevent painful corns. You can reuse them until they flatten out. Just make sure you use tape or a thin band-aid to stick them back on your toe the next day.
Here’s example photos on how to apply the digital corn pads for corns on the top of your toes and in between your toes. You will want to make sure that the hole in the pad is directly over the area of the corn. This will prevent irritation.
Now what if you have corns or ulcers forming on the tips of your toes? How do you remove pressure from the tips of the toes?
I prefer crest pads for this. You simply order a crest pad based on your shoe size, and choose whether you want a pad for the right or left foot. You put the crest pad on your toes and pull on the string below. This pad will literally lift up your toes when you’re walking.
This pad relieves pressure from the tips of your toes. It can help to relieve pain associated with painful corn and ulcers.
If you prefer the smoother pad, you can obtain the gel crest pad.
If you are looking to simply cushion your hammertoes when walking, simple tubefoam works great for this. You can order this in long tubes and cut them to fit your toe. There are plenty of different sizes available to fit each toe. You simply slide them onto your toes.
Orthotics
So you now know that hammertoes can be caused by instability. Simple arch supports can help stabilize your feet and control that instability.
Will wearing orthotics cure your hammertoes? No.
However, by providing stability to your foot, it will prevent your hammertoes from worsening faster.
Taping
Kinesiotape can be used for many ailments. KT tape can help reduce pain and improve circulation. It is latex-free. Wrapping the toes in a downward direction using Kinesiotape can be used to temporarily change the position of the toe and relieve pain at the same time (3).
Again, this is not a cure, but can help with symptoms.
Surgery For A Hammertoe
In people who suffer from hammertoes that cause significant pain, surgery may be an option to consider.
Commonly performed surgical procedures include…
Flexor tenotomy
If your toe is curved but fairly flexible, your doctor may make a small incision on the bottom of your toe to release a tendon that causes contracture. This is fairly non-invasive and activities can be resumed afterward. This procedure has been shown to work well on children as well (4).
This procedure also works to alleviate pressure from the tip of your toe if you suffer from a corn on ulcer on the end of your toe.
Arthroplasty (joint resection)
This is when the bone from the joint causing contracture is removed. This works well to relieve pressure points on your toes that may cause ulcers and corns. Your doctor may splint the toe using a wire called a “K-wire”.
The K-wire can be removed in the clinic post-operatively with no numbing medication. With arthroplasty procedures, due to bone removal, your toe will be slightly shorter.
Arthrodesis (Fusion)
The cartilage on either side of the joint causing the toe to bend is removed. The joint is then fused using implants or a wire. This procedure is commonly done and is effective to reduce pain and improve the alignment of the toe.
Tendon transfer
Sometimes, a tendon on the bottom of your toe can be transferred to the top of your toe to prevent contracture of the toe. This is called a “tendon transfer”.
Post-Surgical Care
After hammer toe surgery, your doctor will suggest that you walk in a surgical shoe for several weeks. You will want to ice and elevate the foot to help with pain and swelling.
If surgery is done on your right foot (your driving foot), ask your doctor when it’s okay for you to start driving again.
Usually, driving is not recommended for the first couple of weeks while you are wearing your surgical shoe and stitches are in.
You can usually go home the same day after the surgery. Stitches will be removed two to three weeks after surgery.
Your doctor will get x-rays every few weeks to assess healing and notify you when you can return to your full activities. In most people, day-to-day activities such as walking can be resumed in 6 weeks after surgery.
In some people, full healing can take up to 3 months. Say for instance you have diabetes and have smoked for over 30 years, your bones and wounds may take longer to heal.
Complications of Hammertoe Surgery
Like with any surgery, complications can happen. Toe surgery is complex.
A study performed by Weil Jr DPM (5) stated that surgery on the second toe was more likely to fail compared to surgery on the third and fourth toes. This can be due to several factors including how the toe drifts in different planes.
Other Complications of Hammertoe Surgeries Include:
Shortened toe
When a certain amount of bone needs to be removed from your toe to be able to straighten the toe, shortening of the toe may occur.
Recurrence of your hammertoe
There are multiple tendons that course above and underneath your toes. In addition, there are ligaments surrounding the joints in the toes. This and your foot structure can affect the bending of the toes. Occasionally, your hammertoe may recur after the surgery.
A floppy toe
When too much bone is removed, a floppy unstable toe can result. This can also occur if you’ve had multiple surgeries on a toe.
Infection
Like with any surgery, infection is a complication that can be seen. If your doctor uses implants or wires, there’s a chance it may need to be removed due to infection.
Joint Stiffness
Since surgery is performed at the joint level, sometimes stiffness can be seen after surgery. This may be especially common if you have pre-existing arthritis.
Malalignment of the toe
Hammertoes are not just bent downwards. The toe is naturally curved and rotated in different directions. Your doctor will try to fix the deformity however malalignment can happen.
Failure of implant or wire
Sometimes implants and wires can loosen or break. This usually requires additional surgery to have it removed.
In Conclusion
Hammertoes can be incredibly frustrating. It’s best to know your options on what can be done to alleviate your discomfort. You don’t have to live with the pain. Seeking treatment for your hammertoe early is essential for pain-relief.
If you have painful hammertoes, how have you treated them? What do you think caused your hammertoes? I would love to hear your thoughts. Leave a comment below!
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References:
- Goransson M, Constant D. (2021) Hammertoe. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021. https://europepmc.org/article/nbk/nbk559268
- Coughlin, M. J. (2000). Common causes of pain in the forefoot in adults. The Journal of bone and joint surgery. British volume, 82(6), 781-790. https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.82B6.0820781
- Żłobiński, Tobiasz, Anna Stolecka-Warzecha, Magdalena Hartman-Petrycka, and Barbara Błońska-Fajfrowska. 2021. “The Impact of Kinesiology Taping on a Greek Foot with a Hammertoe—A Case Report” Healthcare 9, no. 9: 1178. https://doi.org/10.3390/healthcare9091178
- Ross, E. R., & Menelaus, M. B. (1984). Open flexor tenotomy for hammer toes and curly toes in childhood. The Journal of Bone and Joint Surgery. British volume, 66(5), 770-771. https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620x.66b5.6501376
- Weil Jr, L., & Schilling, R. A. (2005). How to handle complications of hammertoe surgery. Podiatry Today, 18 (9). https://www.weil4feet.com/wp-content/uploads/2020/02/Albright-et-al-FAI-2020.pdf
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