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Hammertoe

Dr. Tim Dutra

Reviewed by
Dr. Tim Dutra

Hammertoe is a deformity of the toe in which the toe bends downward at the middle joint, causing it to resemble a hammer. Hammertoes usually begin as mild problems, but over time they can develop into severe cases. Hammertoes are often flexible during the initial stages, and if treatment is administered promptly, symptoms can be managed with non-surgical methods. But if time passes and you do not seek treatment, your hammertoe will become more rigid, and surgical treatment may be required.

This condition is greatly influenced by the footwear we choose. Ladies who wear high heels are a perfect example. High heels force the toes to overlap and bend at the middle joint of the toe, resulting in hammertoe. But high heels are not the only culprits. Anyone who wears shoes that are too tight is increasing their risk of developing hammertoe. This progressive condition, which will only get better with treatment, can cause pain as the toes are forced to bend unnaturally.

hammertoe

Hammertoe 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.

What Causes Hammertoe?

As described above, the main reason people develop hammertoes is improper footwear, or footwear that is too short for the toes. Shoes that do not allow our toes to lie flat are the biggest cause of hammertoes, though there are others, including:

  • Genetics
  • Injury or trauma in which the toe is jammed or broken
  • Diseases that affect the nerves and muscles, such as arthritis
  • Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe

Systematic diseases such as arthritis can also lead to problems such as hammertoe. Some people are born with hammertoes, while others are more prone to developing the condition due to genetics. If you have ever broken a toe, you know there is not much that can be done for it. It is one of the only bones in the body that heals without the use of a cast. A broken toe may be splinted, however, which may help prevent a hammertoe from forming.

Diagnosing Hammertoe

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Hammertoe Treatment

Treatment for a hammertoe usually depends on the stage of the hammertoe and the cause of the condition. If your toe is still bendable, your doctor may suggest conservative care—relieving pressure with padding and strapping, or proper shoes that have a deep toe box and are of adequate length and width. Early intervention can often prevent the need for surgery.

If your toe is not bendable, your doctor may recommend surgery. The type of surgery that will be performed will depend on the severity of the condition. You should expect blood and urine studies before the procedure, as well as x-rays of your feet. Your doctor will inject either a local or regional anesthetic. If your toe has some flexibility, the doctor may be able to straighten it by simply making an incision in the toe to release or lengthen the tendon. If the toe is not flexible, your doctor will probably make the same incision to release the tendon, but he or she may also remove some pieces of the bone so that the bone can be straightened. A k-wire is placed in the toe to help hold it straight while it is healing. This is taken out after about four weeks. Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

If you suffer from poor circulation or diseases such as diabetes, you should consult a doctor. Your doctor may have additional conservative treatments for you.

Complications of Hammertoe

Unfortunately, hammertoe can cause complications before and after treatment. Some people have difficulty walking, while others suffer from foot deformities. Foot deformities can cause pain with walking. Although surgical intervention usually helps in the long term, complications may occur, including excessive bleeding, surgical-wound infection, excessive swelling that may last several months, loss of sensation in the toe, a floppy toe, or an eventual recurrence.

After surgery, call your doctor immediately if you begin to develop any of the following symptoms:

  • Pain
  • Swelling
  • Increased drainage or bleeding in surgical area
  • Nausea or vomiting
  • Signs of infection (muscle aches, dizziness, headache, fever, and ill feeling)
  • New, unexplained symptoms

Preventing Hammertoe

It’s important to understand that preventing hammertoe can sometimes be difficult, since most symptoms do not appear until the condition is well developed. Nonetheless, here are some tips to help you prevent hammertoe:

  • Do not wear shoes that are too narrow or short.
  • Check your children’s shoe size often to ensure that their shoes still fit correctly.
  • Wear comfortable shoes that fit you properly.
  • Remember that your feet widen and lengthen with age.
  • Wear thick-soled shoes if you walk on hard surfaces on a regular basis.
  • Wear shoes with low heels.
  • Have your feet checked regularly by a podiatrist to ensure that no deformities or conditions are developing.
  • Do stretching exercises daily to strengthen the muscles in your feet.

Talking to Your Doctor

Here are some questions you may want to ask your doctor about hammertoe:

  • At what age should I begin looking for symptoms of hammertoe in my children?
  • What types of shoes are best for my feet?
  • What non-surgical treatment options would benefit me most?
  • How severe is my condition?
  • How long should I wait to contact you again for a follow-up visit?
  • Do you have a brochure about hammertoes that I can take home?
  • What measures can I take at home and at work to lessen symptoms?
  • After surgery, how often should I shower or bathe?
  • What additional symptoms should I watch for after treatment begins that might indicate my condition is not improving?

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Medical References:

  1. M. Beers "Merck Manual of Medical Information" 2nd home edition (Pocket Books, 2003) 411
  2. American Academy of Orthopaedic Surgeons, Hammer Toe, http://orthoinfo.aaos.org/topic.cfm?topic=a00160
  3. U.S. National Library of Medicine, Hammer toe, http://www.nlm.nih.gov/medlineplus/ency/article/001235.htm

This page was last updated on September 23rd, 2014



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