A hammertoe is a common foot deformity where the middle joint of the second, third, or fourth toe bends downward, causing the toe to curl up. This abnormal position is caused by an imbalance in the muscles, tendons, and ligaments that hold the toe straight. Improper footwear, such as tight, pointed shoes or high heels, can exacerbate this imbalance by forcing the toe into a cramped, bent state. If left unaddressed, the soft tissues adapt, and the deformity can progress. Intervention ranges from simple at-home strategies to surgical correction.
Non-Surgical Strategies for Correction
Early-stage hammertoes are flexible, meaning the joint can still be manually straightened. Managing this stage focuses on reducing the muscular tension and external pressure contributing to the bend. The first step involves changing footwear to eliminate external compression on the toes. Shoes should feature a deep, wide toe box to provide ample space, and heel height should be kept low. It is recommended that there be approximately a half-inch of space between the longest toe and the inside tip of the shoe.
Physical adjustments help cushion and realign the affected joint during daily activities. Non-medicated pads, gel cushions, or crest pads can be placed beneath the toes to relieve pressure on the bent joint. This minimizes painful friction and the formation of corns or calluses. Orthotic inserts, both over-the-counter and custom-made, offer foundational support by correcting foot alignment and redistributing pressure. Specific orthotic modifications, such as a metatarsal pad, can help lift and separate the toes.
Targeted exercises strengthen the intrinsic muscles of the foot and toes, helping to restore muscle balance. Routines often include ‘towel scrunching,’ where a small towel is pulled toward the heel using only the toes. Another common exercise is the ‘marble pick-up,’ which involves using the toes to grasp and move small objects, improving dexterity and strength. Gently pulling the affected toe straight by hand and holding the stretch for 20 to 30 seconds can also manually lengthen contracted soft tissues.
For temporary relief and alignment, the toe can be held straight using medical tape or over-the-counter toe splints. Taping techniques involve securing the hammertoe to the adjacent toe, known as buddy taping. A loop-and-pull method can also apply constant pressure that encourages a straighter alignment. While these methods do not offer a permanent fix, they provide immediate symptomatic relief and support the toe during walking.
Determining When Medical Intervention is Necessary
A hammertoe begins as a flexible deformity but can become rigid if the underlying soft tissue contracture is not addressed. A flexible hammertoe is easily straightened with manual pressure, indicating that ligaments and tendons have not permanently shortened. A rigid hammertoe is fixed in its bent position due to permanent changes in the joint structure and severely tightened soft tissues. This rigidity makes it impossible to straighten by hand.
Seeking professional medical advice from a podiatrist or orthopedic surgeon is necessary when self-care measures fail to control symptoms. Indications for a consultation include persistent pain, inflammation, or the development of deep corns or ulcers from shoe friction. The inability to comfortably wear most footwear or the presence of a rigid deformity that limits walking also signals advanced progression.
The initial medical assessment involves a physical examination to test the flexibility of the toe joint and evaluate the contracture’s severity. X-rays are used to visualize bone alignment and assess the extent of the deformity and any associated joint damage. These images help the physician determine if the problem is purely soft tissue-related or if bony changes have occurred. This information is used to formulate a treatment plan, ranging from custom orthotics to surgical intervention.
Surgical Procedures for Permanent Straightening
When a hammertoe becomes rigid, or when non-surgical treatments fail to alleviate pain, surgery may be recommended to permanently straighten the toe. The choice of procedure depends on the severity of the deformity and the patient’s overall foot mechanics. One common approach is a joint resection, or arthroplasty. This involves removing a small portion of the bone from the proximal interphalangeal joint. This removal shortens the toe slightly and releases tension, allowing the toe to assume a flatter, corrected position while retaining some joint movement.
Joint Fusion (Arthrodesis)
For more severe or rigid deformities, joint fusion, or arthrodesis, may be performed. This procedure involves removing the cartilage and bone ends on both sides of the affected joint. The toe is then positioned straight and held together with internal fixation. Surgeons commonly use temporary pins, screws, or plates to keep the joint stable while the bones fuse into a single, straight segment. The result is a toe that is permanently straight but rigid at the fused joint.
Soft Tissue Procedures
Soft tissue procedures are often performed with bone correction, particularly for flexible hammertoes or those with significant tendon tightness. A tendon lengthening, or tenotomy, involves cutting or releasing the contracted tendon to reduce the downward pull on the toe joint. A flexor tendon transfer procedure may also be used. This reroutes the flexor tendon from the bottom of the toe to the top, helping to pull the joint into a straighter alignment and stabilize the correction.
Post-operative recovery requires the patient to wear a specialized surgical shoe for several weeks to protect the foot and allow for proper healing. If a temporary pin was used for joint fusion, it is removed in the clinic between two to six weeks after the operation. Weight-bearing is restricted to the heel initially. A gradual return to full weight-bearing begins around four to eight weeks, depending on the specific procedure. Most patients can transition back into supportive, roomy street shoes approximately six to eight weeks post-surgery.