Hammertoe

Overview

When a person has hammertoes, the end of their toe bends downward and the middle joint curls up. Eventually, the toe gets stuck in a stiff, claw-like position. When the inside of your shoe rubs against a hammer toe, corns, blisters or calluses may form on top of the toe or on the bottom of your foot. This can make walking painful. You may also have pain in the joint where your big toe joins your foot. Hammer toe usually affects a person?s second toe (the toe next to the big toe), but it can affect other toes too.

Causes

Hammer toe is most often caused by wearing compressive shoes. It might also be caused by the pressure from a bunion. A bunion is a corn Hammer toe on the top of a toe and a callus on the sole of the foot develop which makes walking painful. A high foot arch may also develop.

Symptoms

A toe (usually the second digit, next to the big toe) bent at the middle joint and clenched into a painful, clawlike position. As the toe points downward, the middle joint may protrude upward. A toe with an end joint that curls under itself. Painful calluses or corns. Redness or a painful corn on top of the bent joint or at the tip of the affected toe, because of persistent rubbing against shoes Pain in the toes that interferes with walking, jogging, dancing, and other normal activities, possibly leading to gait changes.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider's instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

Surgical correction is necessary in more severe cases and may consist of removing a bone spur (exostectomy) removing the enlarged bone and straightening the toe (arthroplasty), sometimes with internal fixation using a pin to realign the toe; shortening a long metatarsal bone (osteotomy) fusing the toe joint and then straightening the toe (arthrodesis) or simple tendon lengthening and capsule release in milder, flexible hammertoes (tenotomy and capsulotomy). The procedure chosen depends in part on how flexible the hammertoe is.

Prevention

Most cases of hammertoe can be prevented by wearing shoes that fit properly and give the toes plenty of room. Some recommended guidelines include avoid shoes with pointed or narrow toes. Avoid shoes that are too tight or short. Avoid high-heeled shoes, which can force the toes forward. If the shoes hurt, don't wear them. Choose shoes with wide or boxy toes. Choose shoes that are a half-inch longer than your longest toe.