Hammer Toe

Our feet contain 25% of the bones in our body. These weight-bearing workhorses are often neglected, with inadequate footwear and improper gait for years taking their toll. We don’t realize how badly we treat our feet until something begins to hurt. Hammer toe is a painful condition in the toe joint that can make any movement painful. Here’s what you need to know.

What is hammer toe?

Hammer toe is a physical deformity that affects the middle joint of the toe. Muscles and ligaments of each toe working together control all movement in your foot. When these toes are forced into an unnatural alignment, the resulting pressure on the toe tendons and joints can result in a bent, stiff, and deformed toe.

When this occurs, the affected toe is forced into a bent, fixed position. The hammer toe is unable to straighten and may actually cross over another toe. Whether the toe is bent in place or crosses over another, this unnatural bend can cause rubbing and irritation on the top of the toe joint, leading to blisters and corns.

These blisters and corns can be especially serious for patients with diabetes or poor circulation. Complications from foot problems due to hammer toe can include infection and tissue death, both of which warrant prompt consultation with a doctor.

Types of hammer toe

Hammer toe can be classified into two categories:

Flexible: The joint allows movement of the toe. Flexible hammer toe is a mild deformity with several non-invasive treatment options.
Rigid: The joint is fixed, and the toe cannot be moved because the tendons have stiffened and pushed the joint out of alignment. The only treatment option for rigid hammer toe is surgery.

What causes hammer toe?

Ill-fitting shoes and high heels that force the foot into an unnatural position are the main causes of this condition. In many cases, high heels with a cramped, pointy toe box put a lot of pressure on the foot and can lead to the deformity.

Other causes include the following.

Genetics: This condition may also be inherited and can occur regardless of what types of shoes are worn.
Arthritis: Arthritis that causes swelling in the joints can also cause hammer toe. Patients may experience pain in the joint and stop moving it as much, causing the joint to stiffen and seize up.
Injury: Any injury to the foot that means less movement can eventually increase the chances of hammer toe.

The symptoms are easy to ignore – until it’s too late. Look for the following signs.

Toe stuck in the inverted “V” position
Irritation on the top of the toe joint, such as swelling, redness, or corns
Inability to move the toe joint
Pain and soreness at the ball of the foot under the bent toe

Ignoring these symptoms can cause the condition to worsen. The toe may eventually cross over the neighboring toe, and the joint will become fixed. Getting prompt treatment is always important.

How to diagnose hammer toe

A physical exam of your foot is the first step, followed by an X-ray to look at the bones of the feet. Doppler ultrasound may evaluate blood flow to your foot if circulation is a concern.

Your doctor will also look at your complete medical history, including:

Any history of foot problems
Other health conditions, such as arthritis or issues with circulation
Any symptoms you are experiencing
What types of shoes you wear

Hammer toe treatment options

In the early stages, there are many non-invasive treatments to ease irritation and prevent the condition from worsening.

These include the following hammer toe treatments:

Wearing low-heeled shoes that fit well and have plenty of room in the toe box
Utilizing orthotic shoe inserts (over-the-counter or custom orthotics) to reposition the toe and lessen foot pain
Non-prescription pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs to decrease inflammation of the toe joint and relieve pain
Over-the-counter remedies for corns or calluses like moleskin, which can relieve pain and irritation on the toe (cutting corns or calluses is not recommended and may cause infection)
Taping or splinting to align the hammertoe to the straight toe next to it
Toecaps or slings to fix the toes in a normally-aligned position

In conjunction with the above non-invasive hammer toe treatments, toe exercises and stretching routines make the toe more flexible and strengthen the muscles. This can result in better alignment.

Toe exercises are performed by carefully pulling the toes, one at a time, to stretch the bent joints. Then, maintain the stretch for a few seconds. You can also use the toes to pick up objects, such as marbles. Placing a towel flat under the feet and employing the toes to scrunch it also increases strength and benefits muscle alignment.

Perform toe exercises several times in the morning and then again in the evening.

Surgery

If your hammer toe is severe and unresponsive to noninvasive treatments, surgery may be an effective treatment option.

Surgical treatments generally include the following three options.

Severing supporting tendons to straighten the toe: This technique is often used in treating flexible hammer toes
Phalangeal head resection (arthroplasty): Reserved for fixed hammer toe, this procedure cuts and realigns the tendons and removes a section of the toe bone
Joint fusion (arthrodesis): Surgical removal of part of the toe joint allows the toe bones to fuse together and is only recommended for rigid hammer toe

It’s important to note that hammer toe may reoccur after surgery. In some cases, even surgery is not enough to return the toe to a normal position. The most successful treatment options include a combination of preventative techniques for healthy feet.