Hammertoes are a contracture – or bending – of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits.
The hammertoe condition is fairly common in cultures that wear shoes. In most cases, this problem can be traced directly to ill-fitting shoes. They tend to slowly get worse with time and frequently flexible deformities become rigid. Treatment can be preventative, symptomatic or curative.
Causes of Hammertoe
A hammertoe is formed due an abnormal balance of the muscles in the toes. In many people, the second toe is actually longer than the big toe, and if shoes are sized to fit the big toe, the second and maybe even the third toe will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels, and the foot is constantly being pushed downhill into a wall with the toes squished like an accordion.
Frequently, hammertoe deformity can develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callous on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callous to form.
- Heredity and trauma
- Wearing shoes that are too tight and cause the toes to squeeze.
- Pain upon pressure at the top of the bent toe from footwear.
- The formation of corns on the top of the joint.
- Redness and swelling at the joint contracture.
- Restricted or painful motion of the toe joint.
- Pain in the ball of the foot at the base of the affected toe.
What Can You Do for Relief?
- Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
- Wear a shoe with a deep toe box.
- If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid heels more than two inches tall.
- A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
- Avoid wearing shoes that are too tight or narrow.
- See your podiatric physician if pain persists.
Treatment of Hammertoe
Treatment depends on how far along the process is. Early on, simply switching to shoes that fit properly may stop the deformity and return the toes to a more normal condition. If the condition is more advanced and the toes will not completely straighten out on their own, a contracture may exist. A contracture occurs when scar tissue tightens a joint and keeps it from moving through its normal range of motion.
If all else fails, surgery may be suggested to correct the alignment of the toe. The main type of procedure performed for these conditions is referred to as an arthroplasty. Arthroplasty is the reconstruction or replacement of a joint.
DIP Joint Arthroplasty
For the hammertoe deformity, an arthroplasty of the DIP joint may be suggested. This procedure is performed through a small incision in the top of the toe over the DIP joint. Once the joint is entered, an arthroplasty is performed by removing one side of the joint. This releases the tension on the ligaments and tendons around the joint and allows the toe to be realigned in the proper position. Once the toe is in the proper position, it is held with sutures (stitches) or a metal pin while it heals.
PIP Joint Arthroplasty
One of the most common procedures to correct the deformity is an arthroplasty of the PIP joint. In this procedure an incision is made over the joint. Once the surgeon can see the joint, the end of the proximal phalanx is removed to shorten the toe and relax the contracture around the joint. The toe is then either held with metal pins or sutures in the straight position until it heals.
MTP Joint Release
If clawing is a problem, then the MTP joint may also have to be released to relieve the contracture of this joint and allow the proximal phalanx to come into the correct position. This procedure is performed by making an incision on the top of the toe over the MTP joint. The surgeon then releases the tight ligaments and tendons until the toe easily moves back into the proper alignment. The toe may be held in the proper alignment with a metal pin until the soft tissues heal. The pin may remain in place for three or four weeks.