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Hammertoes: Causes, Symptoms, Diagnosis & Treatment of a Hammertoe

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Hammertoes can cause problems for those who have them. In severe cases, hammertoes may result in painful corns, ulcerations, and discomfort from friction with footwear. 

In this article, you’ll learn the causes, symptoms, diagnosis and treatment of hammertoe deformities. 

What Is a Hammertoe?

A hammertoe is a condition characterized by the bending of one or more toes. It can affect any toe. 

When a bending deformity occurs in the smaller toes (from the second to the fifth), it is referred to as a “hammertoe”. If the bending occurs in the great toe, it is referred to as a “mallet toe.”

What Causes Hammertoes?

genetics

Genetic Factors

Hammertoes are often a hereditary condition. They arise due to an imbalance between the muscles and tendons in the foot. The tendons in the foot overpower weaker muscles, leading to a gradual bending of the lesser toes over time. 

Individuals with a family history of hammertoes are at a higher risk of developing a lesser toe deformity.

Neuromuscular Disorders

Certain neuromuscular disorders, such as Charcot-Marie-Tooth disease, may predispose an individual to hammertoes. These disorders can disrupt the balance between muscles and tendons in the foot.

In cases of Charcot-Marie-Tooth disease, high-arched feet and hammertoes are commonly seen.

high heels

Impact of Shoe Gear

Inappropriate foot wear is a common factor that contributes to the development of hammertoes. Shoes that are too small or narrow can cause an imbalance in the tendons over time, leading to the formation of toe deformities. 

Women, in particular, are more prone to hammertoes due to their frequent use of high-heeled shoes. These shoes not only have a narrow toe box but also push the foot forward, causing the lesser digits to bend further. 

While footwear may not directly cause hammertoes, it can certainly exacerbate the condition.

Trauma

Any injury to the bones, ligaments, or tendons in the toes can lead to a misalignment or deviation of the toes, causing hammertoes. 

For instance, if a toe sustains multiple fractures, the toe bones can become misaligned over time. Damage to the tendons and ligaments responsible for keeping the toes straight can result in a gradual drift or bending of the toe.

clock

Age

Although age itself is not a direct cause of forefoot hammertoes, the condition tends to worsen over time. Chronic foot instability and improper footwear can accelerate the progression of hammertoes. 

For example, an individual with a family history of hammertoes who has consistently worn flat shoes throughout their life may notice a rapid worsening of the condition over the years.

arthritis toes

Arthritic Conditions

Arthritis, specifically Rheumatoid and Psoriatic arthritis, can increase the likelihood of developing hammertoes. These conditions directly affect the joints in the toes and can lead to joint destruction.

nerve

Conditions Causing Nerve Damage

Certain conditions like diabetes, excessive alcohol use, and stroke that lead to nerve damage in the feet can also cause hammertoes. Nerve damage weaken the muscles and disrupt the balance, causing the toes to bend.

What Are the Symptoms of Hammertoes?

  • Pain and discomfort in the toe (usually the top of the toe)
  • Restricted or Painful Toe Movement
  • Inflammation and Redness 
  • Development of corns and calluses on the toe
  • Visible deformity of the toe
  • Open sores may be present on the toe
  • Swelling in the toe

How Are Bent Toes Diagnosed?

Diagnosis of hammertoes involves an examination by a healthcare professional (Podiatrist). During your appointment, your doctor will conduct a physical examination, assessing your foot and specifically the affected toes.

The physical examination will allow the doctor to visually inspect the deformity and gauge the extent of the condition. They may also evaluate the flexibility of your toe and ask about any associated pain or discomfort you’re experiencing.

To further understand the severity and progression of the condition, your doctor will likely order x-rays. 

These imaging tests will provide a detailed view of the bone structure in your foot, allowing the doctor to accurately assess the degree of bending or misalignment in your toes. Foot x-rays are taken in the office. 

What is the Treatment for Bent Toes?

Non Surgical Treatment to Maintain Toe Health

Treatment for hammertoes varies depending on the severity of the condition and the level of discomfort experienced by the individual. Non-surgical treatment options are listed below.

Appropriate Footwear

For individuals with severe hammertoes, opting for shoes with a deep toe box can alleviate discomfort by preventing the top of the shoe from rubbing against the toes, which could otherwise lead to blisters or corns. 

Consider footwear like athletic shoes with soft, mesh toe boxes that reduce irritation.

Protective Padding

Various types of hammertoe pads can be used to safeguard the toes from blisters, corns, and ulcerations. Options include tube foam, spacers, corn pads, and crest pads.

large toe spacer

small toe spacer

If hammertoes cause rubbing between the toes, foam or gel toe spacers can offer protection.

digital corn pad

For corns on top of or between the toes, adhesive pads like Dr. Jill’s digital corn pads can be beneficial. 

crest pad foot

If corns or ulcers are forming on the tips of the toes, crest pads can be used to lift the toes and reduce pressure.

Orthotics

While they won’t cure hammertoes, orthotics can provide stability to the foot, slowing the progression of the condition. 

Arch supports can help control foot instability, one of the underlying causes of hammertoes.

surgeon performing surgery

Surgical Treatment

For those experiencing severe pain from hammertoes, surgery can be a solution. 

There are several surgical procedures to correct hammertoes that are listed below.

Flexor Tenotomy

This procedure is  recommended for cases where the affected toe is bent but retains a degree of flexibility. 

The surgeon will make a small incision on the underside of the toe to release the tendon responsible for the contraction. The flexor tenotomy is minimally invasive, allowing patients to resume normal activities following the surgery. 

This procedure has proven effective for both adults and children and can also alleviate pressure from the tip of the toe in the case of a corn or ulcer.

Arthroplasty (Joint Resection)

In this procedure, the surgeon removes the bone from the joint causing the contraction. This strategy relieves pressure points on the toes, reducing the potential for corns and ulcers to develop. 

Post-operation, the surgeon will use a wire known as a “K-wire” to splint the toe. The K-wire is removable in a clinic setting without the need for numbing medication.

Due to the bone removal in arthroplasty procedures, the treated toe will be slightly shorter.

Arthrodesis (Fusion)

This procedure involves the removal of cartilage on either side of the affected joint. The joint is then fused using implants or a wire. This technique is used to reduce pain and improve the alignment of the toe.

Tendon Transfer

Occasionally, a tendon located on the underside of the toe may be transferred to the top side of the toe to prevent the toe’s contraction. This procedure is known as a “tendon transfer”.

What Is the Recovery Process Like After Hammertoe Repair?

The patient can generally return home on the day of the surgery. About two to three weeks later, stitches are removed.

Under the doctor’s guidance, patients are advised to walk using a surgical shoe for approximately 4-6 weeks to support the healing of the surgical site.

Regular x-rays are taken every few weeks to monitor the healing progress and the doctor will advise when it’s safe to return to full activities. 

For the majority of patients, normal activities like walking can resume around six weeks post-surgery.  

arthroplasty

What Are Complications That Can Occur After Hammertoe Surgery?

The potential complications following hammertoe surgery are listed below.

  • Hammertoe Recurrence: Despite successful surgery, the complex nature of the foot structure (involving multiple tendons and ligaments) may cause a recurrence of the hammertoe.
  • Toe Shortening: During the procedure, bone removal may be necessary to straighten the toe, which can result in a shorter toe.
  • Toe Malalignment: The multifaceted nature of hammertoe deformities, including downward bending and various curvatures and rotations, may lead to post-surgical malalignment.
  • Joint Stiffness: Since the surgery directly affects the joint, post-operative stiffness might occur, especially in those with pre-existing arthritis.
  • Floppy Toe: Excessive bone removal or repeated surgeries on the same toe could lead to an unstable, floppy toe.
  • Infection: As with all surgeries, there is a risk of infection. In cases where implants or wires are used, they may need to be removed if an infection develops.
  • Implant or Wire Failure: There is a possibility that implants or wires could loosen or break, potentially needing additional surgery for their removal.
How Can One Prevent Hammertoes?

Hammertoe prevention involves adopting the healthy foot habits listed below. 

  • Choose Proper Footwear: Opt for shoes that provide enough room for the toes to move, with a wide and deep toe box. Avoid high heels or shoes with tight toe spaces.
  • Use Inserts or Orthotics: Wear custom-made orthotics or over-the-counter shoe inserts that help maintain foot and toe alignment, relieving pressure points.
  • Exercise Your Toes: Regularly practice toe exercises such as stretching and picking up small objects with the toes to keep them strong and flexible.
  • Maintain a Healthy Weight: Excess weight puts added pressure on your feet, contributing to the development of conditions like hammertoes.
  • Check Feet Regularly: Regular self-examinations can help in early detection of any deformities, preventing further complications.
When Should You See a Healthcare Provider?

It’s important to see a health care provider (foot and ankle surgeon) if you notice persistent pain secondary to foot and ankle conditions like hammer toes. 

Don’t dismiss changes in your mobility, especially if walking or performing normal daily activities becomes difficult. 

Conclusion

In conclusion, hammertoe deformity is a significant concern that can impact a person’s mobility and overall quality of life. It’s crucial to focus one’s efforts on preventative measures such as wearing appropriate footwear and using inserts to maintain proper foot and toe alignment.

Continuous education about foot and ankle health is important and fortunately, there are abundant free resources available to help the public stay informed. 

With these measures, individuals can better prepare themselves to address and prevent hammertoe deformities, thus enhancing overall health and well-being.

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DISCLAIMER: The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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