Overview
A hammertoe is a deformity in the foot, causing the second, third, or fourth toe to be permanently bent in the middle joint, causing the toe to resemble a hammer (hence, its name!) or a claw. They are most commonly found in women who wear narrow shoes, such as high heels, that cause the toes to bend unnaturally for extended periods of time. A hammertoes may be difficult or painful to move, and the skin may become callused from rubbing against the inside of the shoe. In fact, there are two types of hammertoe: flexible and rigid. Flexible hammertoes can still move at the joint and are indicative of an earlier, milder form of the problem. Rigid hammertoes occur when the tendon no longer moves, and at this stage, surgery is usually necessary to fix the problem.
Causes
But what causes the imbalance of the tendons and muscles in the first place so that they begin to pull and bend the joint? A bad fitting shoe could be the cause but it usually isn?t the primary cause. Many people are genetically predisposed to hammertoe, and the condition begins to progress more quickly when they wear shoes that fit poorly, for example pointy toes, high heels, or shoes that are too short. Hammertoe may also be caused by damage to the joint as a result of trauma.
Symptoms
Here is a look at some of the symptoms hammertoe can cause. They include hammer-like or claw-like appearance of the toe. Pain when walking or moving the foot. Difficulty moving the toe. Corns may form on top of the toe. Callus may form on the sole of the foot. During the initial stages, you may be able to manually straighten your toe. This is called a flexible hammertoe. But as time passes, the toe will not move as easily and will continue to look like a hammer. Pressure and irritation over the joint can cause a blister to develop and become a corn over time. These corns have the potential to become infected and cause additional symptoms such as redness, bleeding, and difficulty wearing shoes and socks. Corns are the main cause of pain when hammertoes are developing.
Diagnosis
First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.
Non Surgical Treatment
Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area. Wear a shoe with a deep toe box. If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician?s office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes hammertoe rapidly. See your podiatric physician if pain persists.
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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