Hammertoes are a foot deformity where a toe bends abnormally at its middle joint, causing it to resemble a hammer. This common condition often affects the second, third, or fourth toes, leading them to curl downward instead of lying flat. While a hammertoe can be present at birth, it typically develops over time. Fortunately, hammertoes are treatable.
Understanding Hammertoes
Hammertoes occur due to an imbalance in the muscles and ligaments controlling toe movement, putting pressure on tendons and joints. If a toe remains bent, muscles and joints can tighten, making the bend permanent. Contributing factors include ill-fitting shoes (narrow, high heels) that force toes into unnatural positions. Other causes involve foot structure (high arches, flat feet), traumatic toe injuries, or underlying conditions like arthritis or diabetes.
Symptoms of a hammertoe often include pain, particularly when walking or wearing shoes, and difficulty moving the affected toe. The bent position frequently leads to the development of painful corns and calluses on top of the affected joint, where it rubs against footwear. Swelling or skin discoloration may also be present, and in severe cases, the toe might become rigid, making it impossible to straighten.
Non-Surgical Approaches
For hammertoes that are still flexible and can be manually straightened, non-surgical interventions are typically the first line of treatment. Modifying footwear is often recommended, which involves choosing shoes with a wide, deep toe box to provide ample room for the toes and avoiding high heels or pointed-toe styles. This helps reduce pressure and friction on the affected toe.
Orthotic devices can also provide support and help realign the foot and toes. These may include over-the-counter pads, splints, or custom-made inserts designed to redistribute pressure and improve foot mechanics. Pads can cushion corns and calluses, while taping or splinting can help hold the toe in a straighter position. Custom orthotics can specifically counteract muscle imbalances and prevent the condition from worsening by supporting proper foot alignment.
Specific exercises can help stretch and strengthen the foot muscles, which may improve toe flexibility and balance. Examples include gently stretching the toes manually, picking up small objects like marbles with the toes, or performing “towel curls” by using the toes to scrunch up a towel on the floor. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and reduce inflammation associated with hammertoes. These measures alleviate symptoms and prevent deformity progression.
Surgical Options
When non-surgical treatments do not provide sufficient relief, or if the hammertoe becomes rigid and cannot be straightened, surgical correction may be considered. The type of surgical procedure depends on the severity and flexibility of the toe, and the specific joints involved. Most hammertoe surgeries are performed on an outpatient basis, meaning patients typically go home the same day.
For flexible hammertoes, procedures may include tendon lengthening or tendon transfer. Tendon lengthening involves making a small incision to release a tight tendon, allowing the toe to extend more fully. A tendon transfer reroutes a tendon from the bottom of the toe to the top, which helps pull the bent joint into a straighter alignment and can compensate for muscle weaknesses. These procedures aim to restore balance and straighten the toe without altering the bone structure significantly.
For rigid hammertoes, where the joint is fixed, bone procedures are often necessary. Joint resection, or arthroplasty, involves removing a portion of the bone at the affected joint to allow the toe to straighten. Temporary pins may be inserted to maintain the straightened position during healing, typically removed after a few weeks. Another common procedure for rigid hammertoes is joint fusion, or arthrodesis, where the surgeon removes part of the joint and then uses pins or screws to encourage the bones to grow together, creating a permanently straight and stable toe. This typically results in reduced flexibility but provides long-term correction.
Preventing Recurrence and Future Issues
Preventing the recurrence of hammertoes after treatment, whether surgical or non-surgical, involves ongoing foot care and lifestyle adjustments. A primary strategy is the continued use of properly fitting footwear. Shoes should have a wide toe box, adequate length, and low heels to avoid crowding or forcing the toes into unnatural positions. Trying on shoes at the end of the day, when feet are slightly larger, can help ensure a comfortable fit.
Regular foot exercises, like those used in non-surgical treatment, help maintain toe flexibility and strengthen foot muscles for long-term stability. Consistent use of orthotic devices also helps maintain proper toe alignment, reducing recurrence.
General foot health practices also play a role in prevention. This includes regularly inspecting feet for any signs of irritation or new deformities and addressing corns or calluses promptly. Maintaining overall health, particularly for individuals with conditions like diabetes or arthritis, can impact foot health and the likelihood of developing foot deformities. Adopting these measures supports long-term correction and overall foot well-being.