Hammertoe

Hammertoe and other foot deformities are diagnosed and treated by the Podiatry Division of Premier Medical Group.

What is hammertoe?

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Hammertoe is a foot deformity characterized by the bending of the middle joint of the toes. Rather than having toes that point forward, those with hammertoe have toes that curl downward. The deformity can affect any toe on the foot, but it more commonly appears in the second and third toes. When the deformity first appears, the toes may continue to maintain flexibility. Eventually, the tendons of the toe will contract, tightening the grip and causing the toe to become permanently bent.

Signs of hammertoe can be easy to miss. If you experience any of the following, make an appointment with a podiatrist to receive an evaluation.

  • Corns or calluses
  • Difficulty walking
  • Toe(s) that bend(s) downward
  • Inability to flex the foot or wiggle toes
  • Claw-like toes

Only a doctor can diagnose hammertoe, so if you believe you may have a foot deformity, make an appointment as soon as possible. Hammertoes are a progressive deformity, which means they will only get worse over time.

What does a hammertoe look like?

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Hammertoe appears as an abnormal bend in a toe’s middle joint. This causes the toe to bend upward from the foot and downward from the middle joint, resulting in a hammer-like appearance. While the appearance may resemble other foot deformities, hammertoe specifically affects and alters the appearance of the middle joint, typically in the second or third toe.

What’s the difference between hammertoe, mallet toe, and claw toe?

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There are three common types of toe deformities: hammertoe, mallet toe, and claw toe. Each has distinct characteristics that make them easily identifiable. In most cases, a doctor will examine the joint affected, the toe affected, and the general shape of the toes and foot before providing a diagnosis.

  • A mallet toe often bends down at the joint closest to the tip of the toe, creating a mallet- or gavel-type appearance. This foot deformity often affects the second toe.
  • A claw toe occurs when toes bend up at the joint connecting them to the foot. They will also bend down in the middle joints, as well as the joints at the tip of the toe. Claw toes are affected at every joint in the toe, resulting in a persistent curling.
  • By contrast, a hammertoe bends down only at the middle toe joint, causing this part of the toe to rise upward. Hammertoe most often affects the second toe.

What causes hammertoe and other toe deformities?

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Hammertoe typically begins as a mild deformity and grows progressively worse over time. The most common cause is a muscle/tendon imbalance, which can be aggravated by shoes that do not fit properly. If the toes forced into a cramped position, such as when a tight shoe is worn, or while wearing flip flops for extended periods, a hammertoe can gradually form. In some cases, the foot deformity is the result of an earlier toe trauma, such as stubbing, jamming, or breaking. Hammertoes may also be the result of corns and calluses that can reposition toes while inside the shoe.

Aside from environmental causes, several factors can put you at a greater risk for developing toe deformities. Foot deformity risk increases with age, and women are far more likely to develop hammertoe than men. Diseases like arthritis and diabetes can also predispose a person to developing foot deformities, and heredity is also thought to play a role. The foot’s natural shape, too, can be a risk; those whose second toes are longer than the big toe are more at risk for developing this deformity.

How is hammertoe diagnosed?

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Hammertoe is easily diagnosed with a visit to the podiatrist. During this visit, the doctor will examine your foot and ask about your symptoms. They may attempt to reproduce symptoms by manipulating the foot, which will allow them to study toe contractures. X-rays are often ordered to evaluate the bone and joint structure, especially in severe cases. These images are extremely helpful to practitioners as they develop treatment recommendations.

If the foot deformity is advanced, blood flow may be reduced. As a result, a doctor may order blood flow testing, which can include a Doppler ultrasound, as well as nerve testing if the affliction appears to be severe.

How do you prevent, reverse, and treat hammertoes at home?

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Foot deformities are often prevented by wearing shoes that fit properly. In general, shoes should have adequate toe room, low heels (2 inches or less), and adjustability. This will ensure that the foot is not bent and held in an uncomfortable position for long periods of time. If you want to purchase a new pair of comfortable shoes, do so in the afternoon; feet swell throughout the day, and purchasing shoes when feet are at their largest will ensure optimal comfort.

Over-the-counter shoe cushions and pads are also excellent options for those experiencing discomfort. If you have a hard corn or callus, a foot and/or ankle surgeon will be able to provide or prescribe pads designed to shield the growths from irritation. Orthotic devices can help steady and control the muscle/tendon imbalance, and taping the afflicted toe can gently force the deformity back into a normal position.

If you experience discomfort in your toes, especially in the second or third toe, gently stretch and flex the foot to relieve pain. Towel curls and marble pickups are easy exercises for maintaining joint strength and flexibility, and manually repositioning affected toes can also decrease tendon strain. If the discomfort persists, an anti-inflammatory drug, such as ibuprofen, may reduce pain and inflammation. Corticosteroid injections may also be used to ease pain and inflammation caused by hammertoe. Remember that starting hammertoe treatment immediately may help you avoid surgery.

How do we fix hammertoe with surgery?

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Surgery is typically only needed for severe toe problems, but because hammertoe is a progressive deformity, this more invasive treatment may be necessary. If you cannot move the toe joint or if your toe limits activity, you are likely a candidate for surgery.

There are several types of surgery available for those with hammertoe deformities. We have briefly outlined the most common below.

  • Joint resection: During this surgery, a doctor will cut ligaments and tendons, then straighten the toe. The surgeon may insert temporary pins to keep the toe in place, but they can be removed several weeks after the surgery.
  • Tendon transfer: A surgeon will pull a tendon near the affected toe across the top of the joint. This will pull the toe into a straighter position. This surgery works well for flexible hammertoes. Tendon transfers are often performed with local anesthetic, and recovery times are relatively short.
  • Fusion: A fusion is a typical treatment for fixed hammertoes. During this procedure, the surgeon will remove portions of the joint and the ends of the bones, allowing the bones to grow together. This will straighten the toe and reduce pain. This surgery can be painful, and recovery time is typically longer than a joint resection or tendon transfer.
  • Amputation: This surgery is reserved only for extremely severe cases of hammertoe. If no other treatment works and if a person experiences severe pain, a doctor may recommend removing the toe.

Talk to your doctor about the type of surgery that will best address your pain and toe deformity. In general, hammertoe surgery is performed as outpatient procedures. Depending on the surgery, local anesthetic may be used, allowing a person to remain awake during the operation. This can shorten recovery time. In general, hammertoe surgery is not especially painful.

After hammertoe surgery, patients will typically experience swelling, which can last up to a year. Special shoes or shoe inserts may be recommended to support the toe after the procedure, and patients should avoid placing weight on the foot for several weeks.