A hammer toe is a common foot deformity where an abnormal bending, or contracture, occurs at the joint of the toe, most often affecting the second, third, or fourth toe. This condition causes the toe to resemble a hammer, with the middle joint pointing upward. It typically begins as a flexible deformity that can still be manually straightened. However, it is progressive and can eventually become a rigid, fixed condition if left unaddressed. Managing a hammer toe involves a range of strategies, starting with simple at-home care and progressing to professional medical interventions, including surgery, to relieve pain and correct the alignment.
Daily Strategies for Relief
Immediate relief and slowing the condition’s progression can be achieved through consistent self-care measures focused on reducing pressure and friction. Selecting appropriate footwear is one of the most effective daily adjustments, requiring shoes with a deep and wide toe box to accommodate the bent toe and prevent rubbing. Avoiding pointed-toe styles and high heels is important because they force the toes into a cramped position, which exacerbates the contracture.
Using non-medicated protective padding and cushions offers localized relief by shielding the prominent joint from irritation inside the shoe. Simple cushions, moleskin, or toe pads can be placed over the top of the bent joint, where corns or calluses often form due to friction. For flexible hammer toes, non-rigid splints or medical tape can be used to gently strap the toe back toward a straighter alignment, which helps alleviate the constant pressure.
Specific exercises and stretching help maintain the toe’s flexibility and strengthen the small muscles in the foot, which can counteract the muscle imbalance contributing to the deformity. Simple activities like picking up small objects, such as marbles, with the toes or scrunching a towel on the floor can strengthen the flexor muscles. Gentle manual stretching, where the toe is manually pulled into an extended position and held for several seconds, also helps preserve the joint’s range of motion.
Professional Non-Surgical Interventions
When self-directed care is no longer sufficient to manage pain or slow the progression, professional consultation introduces more specialized, non-surgical options. Custom-made orthotic inserts are a primary intervention, molded precisely to the contours of the patient’s foot. These devices work by correcting underlying biomechanical issues, such as flat feet or high arches, which contribute to the muscle imbalance that causes the hammer toe.
The custom orthotics redistribute the pressure across the entire foot, taking stress away from the affected toe joints and helping to prevent the deformity from worsening. Physical therapy (PT) involves specialized stretching and manipulation techniques administered by a therapist, specifically targeting the contracted tendons and ligaments. A PT regimen may also include prescribed strengthening exercises designed to restore balance to the muscles controlling the toe movement, which is particularly beneficial for flexible hammer toes.
For managing acute pain and inflammation, medical professionals may recommend medication management. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce swelling and discomfort around the joint. In some cases, a targeted corticosteroid injection may be administered directly into the affected joint to provide a potent, temporary reduction in localized pain and inflammation.
When Surgery Becomes Necessary
Surgery is typically reserved for cases where conservative treatments have failed to provide relief and the condition is significantly impacting daily life. The decision to pursue surgery often occurs when the hammer toe has become rigid, meaning the joint is permanently fixed and cannot be manually straightened. Surgery may also be necessary when chronic pain, limited mobility, or the development of non-healing ulcers occur. The goal of the surgical procedure is to permanently straighten the toe and correct the joint deformity.
The specific procedure chosen depends on whether the hammer toe is still flexible or has become rigid. For flexible hammer toes, a less invasive procedure like tendon lengthening or tendon transfer may be performed to release the tight soft tissues pulling the toe into the bent position. For rigid deformities, the surgeon must address the bone structure to ensure permanent correction.
Two main bone procedures are used for rigid cases: arthroplasty, which involves removing a small section of the bone from the toe’s middle joint, and arthrodesis, which is a joint fusion procedure. Arthrodesis involves removing the joint surfaces and allowing the two bones to fuse together, which permanently straightens and stiffens the toe. Both procedures aim to eliminate the abnormal bend and prevent further friction and discomfort.