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Hammer Toe

What is a Hammertoe?

As indicated by its name, a hammertoe resembles a hammer or claw in that the toe is bent downward resulting in a deformed or crooked appearance. Hammertoe occurs in the second, third, and fourth toes and can be very painful. A hammertoe deformity is the result of the middle joint (proximal interphalangeal joint) being contracted which makes the end of the toe bend downwards. There are two types of hammertoe that indicate the severity of the deformity. Each type is classified based on the mobility of the joints.

  • Flexible Hammertoe: Flexible hammertoe is most commonly the first stage of hammertoe and refers to when the toe is able to be straightened manually.
  • Rigid Hammertoe: Rigid hammertoe typically develops following flexible hammertoe and indicates a more severe case of hammertoe. The toe has far more restricted range of motion and can no longer be straightened manually.

What Causes Hammertoe?

Hammertoe results from a muscle imbalance that forces the ligaments and tendons in the toe to be tight and shorten. This draws the toe downward, with the middle joint bent, and creates the characteristic hammertoe deformity. Typically, hammertoe occurs from wearing shoes that fit too tightly and have a tight toe box, not allowing for sufficient space for the toes. Not surprisingly, the incidence of hammertoe is higher in females due to wearing high heels. The design of most high heel shoes not only allows limited room for the toes but forces them against the front of the toe box, bending the toes and not allowing them to lay flat. The chronic bending of toes leads to the muscles, ligaments, and tendons becoming permanently fixed in a bent position. This condition can also be present in individuals with arthritis or diabetic complications such as diabetic neuropathy.

Hammertoe can also occur in children who wear shoes that are too small for their feet. It is important to check children’s shoes and be sure that they fit properly and have not been outgrown. Additionally, hammertoe can result from acute injuries, such as breaking or jamming the toe. In far more rare cases, every toe may be affected due to conditions associated with the nerves or spinal cord.

Treatment for Hammertoe

One of the primary ways to treat hammertoe is to be sure to make sure you are wearing the proper footwear. Proper footwear includes, shoes that have a large toe box, allowing them plenty of space keeping them uncrowded. Avoiding high heels is also a great step in preventing hammertoe. Our physicians at American Foot and Leg Specialists can also prescribe patients with physical therapy and fit patients with braces and splints that force the toe into a normal position which work to stretch the shortened muscles, ligaments, and tendons. Exercises such as picking up marbles with your toes and scrunching up a towel with your toes are often a part of treatment. In more severe cases, surgery is oftentimes necessary. Depending on the case, most hammertoe surgeries often involve cutting or moving ligaments and tendons. Sometimes the bones on either side of the effected joint must be fused together. Hammertoe surgery is considered an outpatient procedure.