Uneven muscle tension results in the distortion of one or several of the small toes. (hammertoes
) Pressure points
develop at the raised hammertoe
middle joint as well as at the tip of the toe and
underneath the metatarsal head. In the beginning, when the misalignment can still be corrected, it often suffices to lengthen the tendon and to cut a notch into the capsule. In a contracted
misalignment, part of the middle joint is removed to form a replacement joint. Modern surgical techniques preserve the metatarsophalangeal joint (Weil or Helal osteotomies).
Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot.
Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problem
(e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid
arthritis, stroke, Charcot-Marie-Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia.
If you have any of these symptoms, do not assume it is due to hammer toe. Talk to your doctor about symptoms such as a toe that curls down, corns on the top of a toe, calluses on the sole of the foot
or bottom of the toe, pain in the middle joint of a toe, discomfort on the top of a toe, difficulty finding any shoes that fit comfortably, cramping in a toe, and sometimes also the foot and leg,
difficult or painful motion of a toe joint, pain in the ball of the foot or at the base of a toe.
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination,
the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the
degree of the deformities and assess any changes that may have occurred.
Non Surgical Treatment
In the early stages, the deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment is delayed too long, permanent stiffness can ensue which can only be corrected by
surgery. The most effective treatment options are good fitting footwear. Shoes with a wide toebox will be more comfortable and will reduce the tension on the muscles and friction on the toes. Avoid
high heels as they push your feet forwards to the front of the shoes. This increases the pressure on the toes, forcing them to bend more than usual. Shoes should ideally be half an inch longer than
your longest toe. Exercises to strengthen and stretch the muscles can be really helpful. Simple things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can
For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the
rigid joint. The sutures remain in place for approximately ten days. During this period of time it is important to keep the area dry. Most surgeons prefer to leave the bandage in place until the
patient's follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and
stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of hammertoe deformity a pin may be required to hold the
toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.