Hammertoes
Foot & Ankle Care of Colorado
Hammertoe is a contracture (bending) deformity affecting one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can cause pressure on the toes when wearing shoes, leading to various problems.
Hammertoes typically begin as mild deformities and progressively worsen over time. In the early stages, hammertoes are flexible, and symptoms can often be managed with noninvasive measures. However, if left untreated, hammertoes can become more rigid and unresponsive to nonsurgical treatment.
Due to the progressive nature of hammertoes, early intervention is crucial. Hammertoes will not improve without some form of treatment.
Causes of Hammertoes
The most common cause of hammertoe is a muscle and tendon imbalance. This imbalance, which leads to the bending of the toe, results from mechanical (structural) or neurological changes in the foot that develop over time in some individuals.
Hammertoes may be aggravated by improperly fitting shoes. If a toe is too long and forced into a cramped position by tight footwear, a hammertoe can develop. Occasionally, hammertoe results from previous trauma to the toe. In some individuals, hammertoes are inherited.
Hammertoe Symptoms
Common symptoms of hammertoes include:
- Pain or irritation of the affected toe when wearing shoes.
- Corns and calluses (a buildup of skin) on the toe, between two toes or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending on their location.
- Inflammation, redness or a burning sensation
- Contracture of the toe
Hammertoe Diagnoses
Although hammertoes are readily apparent, to arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
Hammertoes are progressive—they do not 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.
Nonsurgical Treatments
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend on the severity of your hammertoe and other factors.
A number of nonsurgical measures can be undertaken:
- Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.
- Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels—conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toebox and heels no higher than two inches.
- Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.
When Is Surgery Needed?
In some cases, usually when the hammertoe has become more rigid and painful or when an open sore has developed, surgery is needed.
Often, patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
