What Is Hammer Toe?

Hammer-Toe-PainHammer toe is a physical deformity resulting from a lack of alignment of the muscle and ligament over the toe joint. The affected toe is forced into a bent position and remains fixed, unable to straighten. Ill-fitting shoes and high heels that force the foot into an unnatural position are the main causes of hammer toe, which can occur in any toe. This unnatural bend in the toe can cause rubbing and irritation on the top of the toe joint, leading to blisters and corns. Patients with diabetes or poor circulation may experience serious complications from hammer toe, and any foot problems warrant prompt consultation by a doctor.

Hammer toe can be classified into two categories:

  • Flexible: The joint allows movement of the toe. Flexible hammer toe is a mild deformity, for which there are 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.

Hammer Toe Pathology

Hammer-ToeMovement of the foot is controlled by muscles and ligaments of each toe working together. Lack of alignment in muscles and ligaments places pressure on the toe tendons and joints, resulting in a bent, stiff, and deformed toe. In many cases, high-heels with a cramped, pointy toe space put a lot of pressure on the foot and lead to the deformity. Hammer toe may also be inherited and may occur regardless of what types of shoes are worn. Arthritis or injury to the toe can contribute to the development of hammer toes. The signs and symptoms exhibited are a toe stuck in the inverted “V” position, irritation on the top of the toe joint (swelling, redness, corns), inability to move the toe joint, and pain in the form of soreness at the ball of the foot under the bent toe.

Hammer Toe Diagnosis

Hammer-Toe-ExplainedA physical exam of the foot performed by a physician may be followed by an X-ray to look at the bones of the feet. Doppler ultrasound may be used to evaluate blood flow to the foot if circulation is a concern. The doctor will inquire if the patient has a history of foot problems, arthritis, circulation, symptoms, and what type of shoes are worn every day.

Hammer Toe Treatment

The doctor may recommend non-invasive treatment methods for flexible hammer toe, such as wearing shoes that fit well and have plenty of room in the toe box, as well as a low heel. Orthotic shoe inserts may be used to reposition the toe and lessen foot pain by inhibiting the toe from rubbing on the shoe, becoming irritated. Custom orthotic shoes may provide relief from hammer toe pain.

Hammer Toe MedicationNon-prescription pain relievers such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDS like ibuprofen, aspirin, or naproxen) are effective in decreasing inflammation of the toe joint and relieving pain.

Hammer toe may lead to the development of corns or calluses, which can be treated with over-the-counter remedies (like Moleskin) to relieve pain and irritation. Cutting corns or calluses is not recommended, as this may cause infection.

Non-invasive treatments for flexible hammer toe:

  • Taping or splinting: Application of tape to align the hammertoe to the straight toe next to it, maintaining a straightened position.
  • Toecaps or slings: Another method of fixing the toes in a normally aligned position.
  • Toe exercises and stretching routines: These make the toe more flexible and strengthen the muscles, which results in better alignment. Toe exercises are performed by carefully pulling the toes, one at a time, to stretch the bent joints, maintaining the stretch for a few seconds. Perform toe exercises several times in the morning and then again in the evening. Using the toes to pick up objects, such as marbles, or placing a towel flat under the feet and employing the toes to scrunch it also increases strength and benefits muscle alignment.

If hammer toe is severe and unresponsive to noninvasive treatment, causing significant pain or deformity, surgery may be an effective treatment option. It’s important to note the possibility of hammer toe recurrence after surgery, which may not be completely successful in returning the toe to a normal position.

Surgical hammer toe treatments include:

  • Tension in the toe joint may be relieved by severing supporting tendons, which straightens the toe. This technique is often used in treating flexible hammer toes, while the phalangeal head resection and joint fusion described below are reserved for fixed hammer toe.
  • Phalangeal head resection (arthroplasty): A surgeon 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.
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