Hammertoe is a foot deformity where the second, third, or fourth toe bends abnormally at the middle joint, causing the toe to resemble a hammer or claw. This condition is caused by an imbalance in the muscles, tendons, or ligaments that normally keep the toe straight. The appropriate treatment path—non-surgical or surgical—is determined by the severity and flexibility of the toe’s contracture.
Identifying the Condition
Hammertoes are classified into stages that guide correction. The initial, less severe stage is the flexible hammertoe, where the joint is still movable and can be manually straightened. This flexibility indicates that the soft tissues have not yet permanently tightened.
If the condition progresses, it becomes a rigid hammertoe. The joint becomes fixed and immobile, meaning the toe cannot be straightened even with manual pressure. This rigidity occurs because the tendons and joints have become misaligned and contracted over time, making this stage more symptomatic and challenging to treat conservatively.
Non-Surgical Treatment Options
Non-surgical methods are the first line of defense for flexible hammertoes, aiming to alleviate discomfort and prevent worsening. Footwear modification is foundational: choose shoes with a wide, deep toe box to reduce friction and allow toes to rest naturally. Avoid high heels and shoes with narrow, pointed fronts, as they force the toes into a bent position.
Custom orthotic inserts provide support by addressing underlying foot biomechanics, such as flat feet or high arches, which contribute to the muscle imbalance. These devices redistribute pressure across the foot, helping to improve alignment and stabilize the toes, slowing the contracture’s progression. Padding and protective cushions, such as crest pads or gel cushions, are used to shield the bent joint from shoe irritation, preventing painful corns and calluses.
Specific stretching and strengthening exercises restore muscular balance and improve joint flexibility. Techniques like toe towel scrunches or marble pick-ups engage the intrinsic foot muscles, helping maintain mobility and alignment. Anti-inflammatory medications manage temporary pain and swelling. While these conservative treatments manage symptoms and halt progression, they typically cannot reverse the fixed, rigid deformity found in later stages.
Surgical Procedures for Correction
When non-surgical treatments fail to relieve pain or when the hammertoe has become rigid, surgical intervention is often necessary for permanent correction. The primary goal is to straighten the bent joint and stabilize the toe. Two main procedures are utilized, chosen based on the toe’s rigidity and the surgeon’s preference.
Digital Arthroplasty
Digital arthroplasty involves removing a small section of bone from the middle joint (the proximal interphalangeal joint, or PIPJ) to allow the toe to straighten. This resection aims to correct the deformity while preserving some movement, which many patients prefer. However, it may result in some shortening of the toe.
Digital Arthrodesis
The alternative is digital arthrodesis, a joint fusion procedure where the joint is removed and the bone ends are fused together. The toe is held straight until healing, typically using a temporary pin or small implant, resulting in a permanently straight but rigid toe.
Both arthroplasty and arthrodesis are often combined with soft-tissue procedures, such as extensor tenotomy or tendon lengthening, to release tight tendons contributing to the contracture. These primary procedures may also be supplemented with tendon transfer, where a tendon is repositioned to help pull the toe into a proper, long-term alignment. The decision between arthroplasty and arthrodesis is a patient-centered one, considering factors like age, activity level, and the patient’s desire for a mobile versus a stable, fused toe.
Post-Correction Recovery and Prevention
Recovery from surgical correction typically begins immediately with the patient wearing a special post-operative shoe to protect the foot. For the first one to two weeks, elevation and limiting walking to short periods are necessary to manage swelling and pain. Stitches are usually removed around two weeks, and temporary pins used for fusion are generally removed after four to six weeks once bone healing has progressed.
Physical therapy or a regimen of gentle, prescribed exercises is initiated to re-establish balanced muscle function and prevent stiffness. It can take six to eight weeks before most patients transition back into regular, supportive footwear, though swelling may persist for several months. Long-term prevention relies on careful shoe selection, favoring shoes with a wide toe box and stable support to minimize repetitive friction.
Monitoring foot health and continuing simple strengthening and stretching routines safeguard surgical results and prevent recurrence. Avoiding the underlying causes of the original deformity, such as chronically wearing tight or ill-fitting shoes, is the most effective measure for maintaining the toe’s corrected alignment.