Hammertoes: A Discussion of Symptoms and Treatment

By: Scott Kilberg DPM Click author's name for more of his/her articles

When someone mentions hammertoes, what may instantly come to mind is a severely crooked toe crossing over or under the toes next to it. While this may be true in the severest sense, hammertoes can encompass a wide range of toe position deformity that may not be as noticeable when one looks at their own foot from above, but can still cause symptoms nonetheless. For instance, many people will experience pain across the top of their toes when wearing shoes, and instantly think that their shoe is too tight. While true, that tight shoe is likely only part of the picture. Most of the time, the toes are contracted upward in order to cause the pain. This is a common situation, and can usually be attributed to hammertoes. Other names of toe deformity include claw toes and mallet toes, and all these are defined by which joints in the toe are crooked.

Hammertoes and other related toe contractions are conditions caused by abnormal forces acting on the muscles that control the position of the toes. Seen in people with both flat feet and high arches, the stress placed on the leg muscles by the abnormal arch position causes a change in the position of of the toes over time. This toe position is ultimately inherited since one's arch position is inherited, and represents an imbalance between muscles that pull the toes up and muscles that pull the toes down. Essentially, as the foot and leg adapt to the abnormal arch position over many years of standing and walking, the toes suffer the consequences of this adaptation and gradually contract upward. This can occur at either (or both) of the joints of the toe. It can also occur at the joint of the base of the toe, where the toe meets the foot. The underlying process is different depending on whether one has a high arch or a low arch. As stated above, many people do not notice this contracture, as the toe may not look different when looking down upon it from the top, but a view from the side will show the difference.

When the toes are contracted, areas on the toe can become very prominent against the top of the shoe, typically where the joint, or knuckle, is. This can cause painful corns to form at the area of prominence due to the skin's response to pressure. The skin has a protective mechanism that causes it to thicken it’s top layer in response to abnormal pressure, forming a corn or callus. Corns can even form in between the toes if the bones of adjacent toes rub too closely together under the skin due to the toe's newly deformed position. Additionally, the contracted toes can push down and cause stress to the ball of the foot. Arthritis can potentially develop in the toe joints (although this is uncommon), and some toes (particularly the little toe) can turn inward and cross over or under an adjacent toe. When there is a bunion present and the great toe is pushing into the second toe, the second toe will often ride over or under the great toe.

Treatment can simply include padding to protect the toe from the shoe or other toes, as well as regular trimming of the corns. Padding comes in all shapes and sizes, but the most effective type seems to be elastic sleeves with gel on the underside. These pads simply slip on over the toes, and act like a sock or sleeve to cover and pad the skin. Trimming of the corns can be done at home with an emery board or pumice stone only. If the corn is thick enough to require a knife, let a podiatrist do the work to avoid a serious injury to the skin. There have been many cases of people cutting off parts of their toe skin accidentally when using a knife or razor blade, especially with those who are diabetic and have poor sensation. Deeper shoes are vital to stop the pressure of the shoe from irritating the toe. Many women’s dress shoes are simply too narrow or shallow for correct toe fitting, and women in particular seem to suffer from hammertoe pain more commonly than men. Orthotics (prescription shoe inserts) in some instances may control the progression of the toe contraction, however, never let any shoe or arch support store fool you into thinking orthotics can cure hammertoes. Permanent correction can only be achieved through corrective surgery to straighten the toes and remove any prominent bone. These procedures are generally easy to recover from, and most people are back into their regular shoes within a month from a post-operative recovery sandal. The procedure usually involves removal of part of the toe bone at the joint that is most prominent, allowing the toe to settle back down. The space created by this bone removal acts as a new joint, replacing the part of the joint removed during the procedure. Often other procedures are also used to rebalance tight and abnormally positioned soft tissue, and occasionally a tendon from the bottom of the toe is transferred to the top to rebalance the flexing force on the toe. External removable or internal absorbable pins are used to keep the toe straight while it heals, as scar tissue will cause the toe to deform again if not maintained in a proper alignment during the recover period. Occasionally, severe cases require toes to be partially fused, and this extends the healing time by a couple weeks. This fusion allows the toes to remain rigidly straight. It is used in cases in which there is great of instability of the toe, when the toe is expected to become contracted again soon due to neurological disease, or when there is arthritis. Essentially, one or more of the joints in the toes are made to fuse together, eliminating motion out right. The rigid toe that results from this is very stable, resistant to further change, and painless. A combination of internal or external wires, pins, or implants can help the bone bridge together, which usually takes 5-6 weeks to occur.

As you can see, this relatively common foot problem can be easily treated and, for those who need it, permanently corrected. If one’s toes hurt in shoes or against the ground, it is advised that one seek care from a foot specialist (podiatrist) for definitive treatment.

Article Source: ABC Article Directory

About The Author: Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website at www.inpodiatrygroup.com