A hammertoe is a common foot deformity where one of the lesser toes, typically the second, third, or fourth, bends abnormally at the middle joint, causing it to resemble a hammer or claw. This condition arises from an imbalance in the muscles, tendons, and ligaments that usually work in pairs to keep the toe straight. Over time, often due to improperly fitting footwear, the toe joint tightens and becomes fixed in the bent position, leading to pain, corns, and difficulty wearing shoes. Treatment for this condition ranges widely, depending on whether the toe is still flexible or has become rigid, and the full scope of options extends from simple at-home measures to complex surgical procedures.
Non-Surgical Approaches to Correction
Conservative treatment is recommended for flexible hammertoes, where the joint can still be manually straightened. Treatment focuses on modifying daily habits, starting with significant changes to footwear. Shoes must feature a wide, deep toe box to allow the toes to lie flat and move naturally without crowding. Avoiding high heels is also necessary, as they force the foot forward and increase pressure on the forefoot.
Protective padding and specialized devices manage symptoms and prevent progression. Non-medicated felt or moleskin pads can be placed directly over corns or calluses on the raised joint, reducing irritation. Taping or splinting techniques may also be used to hold the toe in a straighter position, helping to stretch contracted soft tissues over time.
Targeted exercises restore muscle balance and flexibility, particularly for the small intrinsic muscles of the foot. Routines include picking up small objects, like marbles, or attempting to scrunch up a towel placed on the floor. Gentle manual stretching, where the toe is carefully pulled straight, helps maintain range of motion and prevents the joint from becoming rigid. Custom orthotic inserts may also be beneficial if the hammertoe is linked to an underlying biomechanical issue like flat feet or high arches.
Surgical Procedures When Necessary
Surgical correction is recommended when a hammertoe becomes rigid or when conservative treatments fail to provide adequate relief. The goal of surgery is to permanently straighten the toe, relieving pain and allowing the foot to fit comfortably into normal footwear.
Arthroplasty (Joint Resection)
Arthroplasty is a common approach for rigid hammertoes. This procedure involves removing a small portion of the bone from the affected middle joint, which shortens the toe slightly and allows it to straighten. This bone removal allows the soft tissues to relax and the toe to decompress.
Arthrodesis (Joint Fusion)
Arthrodesis, or joint fusion, is another technique used for fixed deformities, especially in the second and third toes which require more stability. In this surgery, the cartilage is removed from the joint surfaces, and the bones are permanently joined together. Pins, wires, or screws are often used to stabilize the toe while the bones fuse, resulting in a stable, straight toe.
Tendon Transfer
For flexible hammertoes that have not responded to non-surgical care, a Tendon Transfer procedure may be utilized. This involves rerouting a tendon from the bottom of the toe to the top, using the tendon’s tension to pull the joint into a straight position. Surgeons may also perform a Tendon Lengthening or release during any of these procedures to adjust the soft tissues contributing to the contracture.
Preventing Recurrence and Long-Term Care
Long-term care focuses on preventing the deformity from returning or worsening after any intervention. Proper shoe selection remains the most important preventative measure for managing hammertoes throughout life. Shoes must feature a deep, roomy toe box made of soft, flexible materials, such as leather or fabric, which conform to the foot without creating pressure points.
Heel height should be kept low, ideally under one inch, to prevent the foot from sliding forward. When purchasing new footwear, shop later in the day, as feet naturally swell, ensuring the fit accommodates the foot at its largest. It is recommended to ensure there is at least a half-inch of space between the longest toe and the end of the shoe.
Following surgery, initial recovery involves wearing specialized post-operative shoes for several weeks to protect the corrected toe. Maintaining the toe’s alignment is paramount during this phase. Regular self-checks of the feet are important to identify early signs of friction. Consulting with a podiatrist periodically ensures that any muscle imbalances or structural issues are addressed promptly, supporting long-term foot health.