A hammer toe is a common foot deformity characterized by an abnormal bend in the middle joint of the second, third, or fourth toe. This contracture can be uncomfortable and make wearing shoes difficult. Hammer toe is often fixable without surgery, particularly when addressed early while the toe is still flexible. Treatment depends heavily on the stage of the deformity, ranging from conservative measures to surgical intervention.
How Hammer Toe Develops
Hammer toe formation is a biomechanical process rooted in a muscle and tendon imbalance within the foot. Muscles work in pairs to control toe movement; when the flexor tendons pulling the toe downward overpower the extensor tendons, the toe is pulled into the bent position at the proximal interphalangeal (PIP) joint.
This imbalance is often exacerbated by external pressure, most commonly from poorly fitting footwear. Shoes that are too short, too narrow, or have a tight toe box push the toes into a flexed position. High-heeled shoes are particularly damaging as they force the foot down and jam the toes against the front of the shoe. Over time, the muscles and tendons shorten, causing the joint to become rigid and unable to straighten manually. Foot structure, such as a high arch or flat feet, can also alter foot mechanics and place undue stress on the toe muscles.
Conservative Methods for Correction
When a hammer toe is flexible—meaning it can be manually straightened—non-surgical treatments offer the best chance for correction and relief. The goal is to reduce pressure, alleviate pain, and restore muscle balance.
Padding and Taping
Specialized padding and taping techniques are foundational steps. Non-medicated pads or cushions can be applied over the bent joint to shield corns or calluses that develop from friction. Taping the toe to an adjacent straight toe or strapping it with specialized devices can help gently realign the toe and prevent further contracture.
Orthotics and Exercises
Custom orthotic devices and shoe inserts are frequently employed to address underlying mechanical issues. These inserts are molded specifically to the patient’s foot, helping to redistribute weight and pressure evenly. By addressing structural problems, such as excessive pronation or a lack of arch support, orthotics reduce the strain on the toe tendons contributing to the deformity.
Specific physical therapy exercises are also recommended to strengthen the intrinsic foot muscles and stretch the tightened tendons. Activities like picking up small objects, such as marbles, with the toes or performing “towel curls” help to re-establish muscular equilibrium.
Surgical Options for Permanent Repair
When a hammer toe becomes rigid or when conservative treatments fail, a permanent repair requires surgery. Surgery is designed to physically straighten the joint and is recommended for patients experiencing severe pain that impacts daily activities. The procedure is often performed on an outpatient basis.
There are two main categories of surgical procedures: arthroplasty and arthrodesis.
Arthroplasty (Joint Resection)
Arthroplasty involves removing a small portion of the bone from the middle joint of the toe to create space and allow the toe to straighten. This technique preserves some degree of motion in the joint and is often preferred for a quicker return to activity.
Arthrodesis (Joint Fusion)
Arthrodesis involves excising the joint surfaces and securing the two adjacent bones together with an implant to promote bone growth across the gap. Fusion provides a highly stable, permanent correction but results in a completely rigid joint.
Recovery generally involves wearing a specialized surgical shoe, with a full return to normal activity often occurring within four to six weeks, depending on the specific procedure.
Lifestyle Adjustments to Maintain Foot Health
Maintaining foot health after treatment depends heavily on long-term lifestyle adjustments, primarily centered on footwear. Choosing shoes with a proper fit is paramount to preventing the recurrence of the deformity. The most important feature is a roomy and deep toe box that allows the toes to spread out naturally.
Footwear should be at least one-half inch longer than the longest toe and offer a low heel with sufficient arch support. Avoiding high heels and narrow, pointed-toe shoes is a permanent change that protects the corrected toe from compressive forces. Regular self-checks of the feet for signs of pressure or the formation of calluses can help catch developing issues early.