Hammer toe & the toe joints

Anatomy

Hammer toe impacts the second, third, and fourth toes. This issue occurs when the middle joint, known medically as the PIP, or the proximal interphalangeal joint, bends inward. This abnormal movement makes the toe look like a hammer, which describes the condition’s name.

About

Hammer toe is a common foot condition with more than 200,000 cases in the United States every year. The toe has an abnormal bend in the middle joint, causing it to bend or curl downward instead of pointing forward. Hammer toe most commonly affects the second or third toe.

Causes

Researchers believe that the condition’s root cause is a foot muscle imbalance resulting in excessive pressure placed on a toe’s soft tissues like ligaments and tendons. Wearing improper footwear is usually the most significant contributing factor.

This is particularly true of dress shoes like high heels. The foot’s pathway grows narrower in this type of shoe, which causes the middle toes to bend inward more than they are used to. This bending is only heightened when individuals walk because these shoes have such strong heel force.

When you wear high heels or only wear them a few times, foot muscles compensate by straightening the affected toes. But as the shoes are worn more often, the muscles weaken and grow less capable of performing the corrective action. The result is the onset of hammer toe.

There are several reasons a person may develop a hammertoe. These reasons include:

• Wearing high heels or improperly fitting shoes that crowd the toes.
• Having other underlying diseases such as multiple sclerosis, rheumatoid arthritis or diabetes that affect the feet and joints.
• Suffering a traumatic injury.
• Pressure from a bunion.
• Flat feet.

Symptoms

The most obvious symptom is the bending of the affected toe.

This physical problem is also often accompanied by other occurrences, including:

• Toe pain
• Discomfort that worsens when you move the toe or puts shoes on
• Difficulty walking
• Trouble standing or bearing weight on the injured toe and foot

The damaged toe can develop painful growths like corns or calluses. They can intensify pain and other symptoms.

Hammertoes can be quite painful. Once one has developed, it may be extremely painful to wear any type of restrictive shoes. If left untreated, a hammertoe may result in a serious fixed deformity where the toe cannot be straightened.

The symptoms of a hammertoe include:

• A claw-like deformity of the toe.
• Redness and swelling around the affected toe.
• Corn and/or callus formation on the top of the toe where it bends and rubs shoes.
• Callus formation on the sole of the foot.
• Joint pain in the toe.
• Changes in gait or balance.

Diagnosis

Moderate to severe hammer toe is readily visible, which makes the condition somewhat easy to diagnose. Your physician will still move the affected toe to gauge its flexibility levels and help determine the most appropriate treatment.

In some cases, diagnostic imaging like X-rays may be required to complete the diagnosis. Occasionally, your physician might use various other diagnostic tools to rule out other conditions.

Treatment

Hammer toe is treatable, and it is simplest to address during its early to middle stages. Severe instances may need surgery.

Nonsurgical treatment options

Most hammertoes, particularly those in the early stages, are treated conservatively. Most physicians prefer to try non-surgical treatments first. The most direct remedy is the use of different footwear. Your physician will likely suggest that you refrain from wearing high heels or any other shoes that leave their toes little, if any, wiggle room. It is recommended that hammer toe sufferers wear footwear that is at least a half-inch longer than their big toe.

When a hammer toe takes hold, you can usually benefit from wearing shoes that help accommodate the problem. Shoe repair shops or specialty establishments may be able to extend a shoe’s length to fit the toe in question comfortably.

Non-surgical treatments may include the following:

• Wearing properly fitting shoes that are designed with a high, wide toe area to accommodate the forefoot.
• Using foot manipulation and splints for the affected toe.
• Strengthening toe muscles with exercises.
• Wearing custom orthotic devices in the shoes to keep the feet properly aligned and stable, and to provide extra comfort, support and protection.
• Using products such as corn pads or felt pads to help prevent irritation.

Over-the-counter aids

Items like cushions or orthotic devices placed inside shoes can make walking or exercising more pleasant and ease any associated discomfort. Using over-the-counter anti-inflammatory or pain medications may also be helpful.

Surgical procedures

In instances where you experience severe pain or mobility issues or the toe in question no longer moves, surgery may be required. The specific intervention a doctor recommends will depend on the condition’s severity. Commonly performed operations include:

• Tendon transfer – During this procedure, a surgeon transfers a healthy tendon from the top of the patient’s toe into the middle, which can help straighten the hammer toe.
• Tendon lightening – This surgery extends the tendons responsible for causing the joint abnormality in patients with flexible enough toe joints.
• Joint fusion – This operation, which is referred to as arthrodesis, is usually performed on persons with rigid joints and pronounced cases of hammer toe. Surgeons remove a tiny part of bone near the toe joint. This action enables the damaged toe to extend. During the second stage of this procedure, the surgeon inserts a metal plate, pin, or wire, into the bones connected to the affected joint. This enables the bones to eventually fuse together and keep the toe straight.

These procedures are typically performed on an outpatient basis. The full recovery period usually takes somewhere between four to six weeks.

Prevention

Not all incidents of hammer toe can be prevented. But some cases can be stopped or slowed in provided people:

• Wear appropriate footwear – If you are required to wear high heels, you should wear wider, more comfortable shoes.
• Exercise – Toe-strengthening exercises may prevent or reduce the chance of developing the condition. Specific movements, including curls, extensions, and splaying, often provide long-term benefits.

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