is defined as a deformity in the toe
where part of the toe
is permanently bent downward resembling a hammer. Two related conditions are mallet toe
and claw toe
which effect different toe
joints in slightly different ways. The key difference is that hammertoe
tends to effect the middle joint in the toe
(note: not the middle toe
, the middle toe
joint). The disease is usually associated with the second largest toe
but can effect the third or fourth toe
as well. Mallet toe
effects the uppermost toe
joint whereas claw toe
is caused by the tow being held in a cramped ?claw-like? position.
A common cause of hammertoe and mallet toe
is wearing improper footwear - shoes that are too tight in the toe
box, or high-heel shoes. Wearing shoes of either type can push your toes forward, crowding one or more of them into a space that's not large enough to allow your toes to lie flat
. Hammertoe and mallet toe
deformities can also be inherited and may occur despite wearing appropriate footwear. The result is a toe
that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe
or toes, causing painful corns or calluses. The bottom of the affected toe
can press down, creating the mallet-like appearance of mallet toe
. At first, a hammertoe or mallet toe
may maintain its flexibility and lie flat
when you're not wearing crowded footwear. But eventually, the tendons of the toe
may contract and tighten, causing your toe
to become permanently stiff.
The most obvious symptom of hammer, claw or mallet toe
is the abnormal toe
position. This is usually combined with pain: the abnormal foot position leads to excessive friction on the toe
as it rubs against any footwear which can be extremely painful. Corns & Calluses: repeated friction can result in the formation of a foot corn or callus on top of the toes. Stiffness, the joints become increasingly stiff. In the early stages, the toes can usually be straightened out passively using your hands, but if allowed to progress, the stiffness may be permanent.
Hammertoes are progressive, they don?t go away by themselves and usually they will 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
Pad it. Mild cases of hammertoe can be treated with corn pads or felt pads available in the pharmacy. Toe
caps, the small, padded sleeves that fit around the tip of the toe
, may relieve hammer toe
pain. Change your shoes. Wear Hammer toe
wide shoes with resilient soles. Avoid shoes with pointed toes. Exercise. Certain exercises such as moving and stretching your toe
gently with your hands and picking small or soft objects such as marbles or towels can keep your toe
joints flexible. Also, while you are watching television or reading, you can also put a towel flat
under your feet and use your toes to crumple it. This simple exercise can stretch and strengthen your muscles. Use ice. If your hammer toe
becomes painful, applying an ice pack several times a day can help relieve the soreness and swelling.
Take medications. Nonsteroidal anti-inflammatory medicines (also called NSAIDs), such as ibuprofen or naproxen may be helpful in minimizing pain and inflammation. Use orthotic devices. Place a custom orthotic device in your shoe. This will help control the muscle/tendon imbalance.
The deformity is corrected in a variety of ways. There are actually a large number of procedures. The simplest procedure would involve a Tenotomy, the cutting of the tendon causing the deformity or a Tendon Lengthening procedure. These procedures are infrequently done, though, as the structural deformity (the arthritis and joint adaptation) is not addressed with these surgeries. Other soft-tissue procedures involve rebalancing the tendons around the joint. There are several techniques to do this, but the most common is probably the Girdlestone-Taylor procedure, which involves rerouting the tendons on the bottom of the toe
up and over the toe
where it sticks up, so that the tendon helps pull the toe
downwards into proper alignment.
The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate the existing condition and can also cause the condition to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.