1. What is a hammertoe?

Hammertoe is an abnormal bending of the smaller toes in the foot. In medicine, the toes are numbered 1-5 with the big (or great toe) being number one and the pinky (or smallest toe) being number five. Hammertoe deformities are not cosmetic in nature. The toes bend at the joint constantly, causing abnormal pressures on the knuckle of the joint or the tip of the toe. The pressure at the top of the toe can rub against shoes, causing pain or soreness. For patients with neuropathy (who lack feeling in their toes), hammertoes can even lead to non-healing wounds and amputations. Hammertoes usually start off as a flexible deformity in its early stages and can be managed with non-invasive measures. Hammertoes do progress, however, and should be addressed early in the process.

2. What causes a hammertoe?

There is a saying that form follows function. At times, hammertoes are congenital, meaning that a person is born with the extra bend in the toes. This extra bend in the toes usually does not cause a problem if the toes are flexible. When pressure is applied to the toe, the deformity with reduce. The idea behind the phrase “form follows function,” is that as the deformity persists and progresses the body will begin to freeze the joint in its most common position. For a hammertoe, the toe finds itself in a permanently bent position.

Tight shoe gear can also lead to a hammertoe deformity. The toe being cramped in the toe box of a shoe will cause the foot to memorize the position. The toes are also forced out of their alignment in a cramped shoe, destabilizing the natural pull of the tendons.

The most common cause of a hammertoe is a muscle/tendon imbalance. In a traditional hammertoe, the muscles and tendons that pull the toe down are stronger than the muscles and tendons that pull it up. This imbalance causes the toe to contract and bend down. The imbalance can be a mechanical problem or a neurological (electrical) problem that may develop in some people over time.

Occasionally, hammertoes can be caused by wear and tear or blunt trauma to the toe. Some excessive pressures can cause the soft tissue structures in the toe to wear out, and the toe can drift. This is the most common cause of a “floating type” of hammertoe.

The biggest concern for hammertoes is the calluses that can develop because of the abnormal wearing on the skin. Calluses (corns) are caused by constant friction against the shoe or excessive force through the skin against the ground. Depending on the location of the calluses, they can present themselves as either hard or soft. They can blister or the skin under the callus can sometimes wear away leaving a break in the skin which could lead to infection.

3. What are the symptoms of a hammertoe?

Common symptoms of hammertoes include the following:

• Pain, redness, or irritation from shoe gear rubbing on the toe
• Calluses on the top of, between, or on the tip of the toe
• Inflammation, redness, and swelling of the toes
• Contraction of the toe
• In more severe cases, open wounds or sores can form on the toes

4. What treatments are offered for hammertoes?

A variety of treatments–both conservative and surgical–exist for the treatment of hammertoes. When discussing treatments with patients, we try to tailor the treatment to the patient’s goals and severity of the deformity.

Nonsurgical options include the following:

• Padding of corns and calluses: foam or silicone pads are helpful to alleviate the pressure
• Change in shoewear: shoes with a wide toe box are helpful in alleviating the pressure on the toes. A stretchable fabric can also accommodate the deformity (mesh and lycra are examples of forgiving fabrics)
• Orthotic devices: a custom orthotic device placed in your shoe may help control the muscle/tendon imbalance
• Medications: oral, non-steroidal, anti-inflammatory drugs (NSAIDs)–such as ibuprofen–may be recommended to reduce pain and inflammation
• Splinting/strapping: splints are often used to pull the toes straight and maintain the correction. Strapping and splints are really only helpful for flexible deformities.

5. What surgical options are there for hammertoes?

When discussing surgical options for hammertoes, multiple factors are taken into consideration. At Next Step Foot and Ankle, we strive to perform the procedures that require minimal recovery in order to get our patients back on their feet again. We also take into consideration the severity of the deformity when determining what procedure will best fix the deformity. A patient’s overall health also determines what type of surgeries may be indicated. Another consideration when treating hammertoes is a patient’s blood flow. We typically order a blood flow study to determine the percentage of blood making it to the toes versus what comes out from the heart. Good blood flow leads to good surgical outcomes. A variety of procedures are used to treat hammertoes and all of these factors must be considered when choosing the best treatment for a patient.

For more information about hammertoes and to get a copy of this month’s Patient Newsletter featuring the condition, CLICK HERE.