Hammertoe
A hammertoe is a deformity of the second, third, or fourth toe. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Hammertoes typically start as a flexible deformity but if left untreated could potentially develop into a fixed/rigid deformity that may require more aggressive surgery to correct.
Symptoms
People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They also may feel pain in their toes or feet and have difficulty finding comfortable shoes. The most common complaints are the middle joint of the hammertoe rubbing against the top of the shoe or the tip of the toe digging into the ground.
Causes
Hammertoe results from shoes that don’t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out.
Shoes that narrow toward the toe push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles are unable to straighten the toe, even when there is no confining shoe.
Treatments
Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. Avoid wearing tight, narrow, high-heeled shoes. You may be able to find a shoe with a deep toe box that accommodates the hammertoe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.
Your foot and ankle orthopedic surgeon may recommend toe exercises that you can do at home to stretch and strengthen the muscles. For example, you can gently stretch the toes manually. You can use your toes to pick things up off the floor. While you watch television or read, you can put a towel flat under your feet and use your toes to crumple it.
Finally, your surgeon may recommend that you use straps, cushions, or non-medicated corn pads to relieve symptoms. If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.
Hammertoes can be corrected with surgery if conservative measures fail. Usually it is an outpatient procedure, meaning the patient can go home the same day as surgery, done with a local anesthetic. The procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling, and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and you should keep your foot elevated as much as possible.
It is possible that after surgery your hammertoe may come back. If this happens and you have discomfort in the toe, an additional surgery may be needed to address the pain.
