Hammertoe

What Is a Hammertoe?

A Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with without surgery. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Causes

The most common cause of hammertoes is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from structural changes in the foot that are often hereditary.

Hammertoes are aggravated by shoes that don't fit properly. A hammertoe may result if a toe is too long, and is forced into a cramped position when a tight shoe is worn.

Symptoms

Common symptoms of hammertoes include:

  • Pain or irritation on top of the toe where it impinges against the shoe.
  • Corns and calluses on the toe, between two toes, or on the ball of the foot. Corns are caused by friction against the shoe or against other toes. They may be soft or hard, depending upon their location.
  • Inflammation, redness, or a burning sensation
  • Contracture of the toe
  • In more severe cases of hammertoe, open sores (ulcers) may form.

Diagnosis

Although hammertoes are readily apparent, your foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. X-rays will be taken to determine the degree of the deformities and assess any changes that may have occurred.

Hammertoes are progressive - they don't go away by themselves and usually get worse over time. However, not all cases are alike - some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non-surgical Treatment

  • Padding corns and calluses - Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types which contain an acid that can spread to normal skin.
  • Changes in shoewear - Avoid shoes with pointed toes and high heels. Such shoes force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe boxes and heels no higher than two inches.
  • Orthotic devices - A custom orthotic device placed in your shoe can help control the muscle/tendon imbalance, and slow or stop progression of hammertoes.
  • Injection therapy - Steroid injections can ease the pain and inflammation caused by hammertoes.
  • Medications - Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

When Is Surgery Needed?

Surgery is needed when a corn develops over the toe, the hammertoe has become more rigid and painful, or when an open sore develops. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your activity level, and other factors.

In recent years, the doctors of North Shore Foot & Ankle have used a small internal device (implant) to maintain correction of the hammertoe. This eliminates the need for pins that protrude from the foot during healing. It also allows patients to return to shoes more quickly than with traditional surgery. If you have a hammertoe, ask your doctor if you are a candidate for this new technique.

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