high heels

The Connection Between Hammertoes and Shoe Choice

Is hammertoe a genetic condition or can it be caused by the type of shoes you wear?

Do you ever notice how some people tend to always wear closed-toe shoes, no matter the season or location? While most can’t wait to toss their shoes to the back of the closet at the beginning of summer and live in sandals and flip flops until the first autumn frost, there are always some who rarely enjoy this simple pleasure. One explanation for this is likely to be an unsightly foot condition, like hammertoe.

Hammertoe is what is referred to as a “contracture deformity”. This means that there is some sort of unnatural bending. With hammertoe this unnatural bending is found in the second or middle joint, typically of the second, third, or fourth toes, although it can sometimes affect the fifth or little toe. The name hammertoe was coined due to the bent toe taking on the appearance of a hammer, which also explains the motivation of wanting to keep it hidden. 

What Causes the Development of Hammertoe?

The actual cause of a toe becoming bent in an unnatural position is that there is an imbalance in the surrounding support structure, the muscles, ligaments, and tendons that are supposed to keep the bones of the toe in proper alignment. That is the mechanical or structural description of what happens to pull the toe out of alignment, but why that takes place is, perhaps, a more useful discussion. What causes the imbalance in the first place?

There is a range of causes for the breakdown of structural support that leads to the development of hammertoe. Simple aging can be a factor, as it seems to be in the lengthy list of conditions that develop or worsen as we get older. Heredity may also play a role and hammertoe does tend to show up more often in those whose relatives also have the condition. Some of the other common causes include:

  • Injury or trauma to the muscles, tendons, or ligaments in the foot
  • Other structural conditions present in the foot, especially the second toe being longer than the big toe, high arches, flat feet, or toes being pushed out of alignment due to pressure from a bunion
  • Diabetes, arthritis, stroke, polio, and other diseases that have been found to often be associated with hammertoe
  • Tumors located in the spinal cord
  • Ill-fitting footwear

Poor choice of shoes may be at the end of our list but it is actually one of the most common causes attributed to hammertoe development. By this point, it should go without saying that shoes that are too tight or narrow in the toe region are extremely bad for your feet. For some, this may be unintentional and just a lack of understanding of how to get a proper fit, but, for many, this is a fashion statement that has caused pain and deformity in generations of women. Hammertoe is a prime example of what pointy-toed, high-heeled shoes can leave in their wake.   

If you suspect you may be developing hammertoe, it is important to make an appointment with your orthopedic specialist as soon as possible. Hammertoe is a progressive deformity. If you catch it early and make the necessary corrections and interventions, it may never get to the point where you miss the joy of walking barefoot on the beach without worrying about anyone staring at your toes. 

If you have questions or concerns about any foot or ankle issues, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Passaic County New Jersey, and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.

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