Hammertoe is an abnormal bending of the middle joint in the toe. It is referred to as a contracture deformity, which means unnatural bending. Typically, this condition is due to an imbalance between the muscles, ligaments, and tendons, which results in their no longer being able to keep the bones in alignment. Hammertoe can affect the second, third, fourth, and fifth toes, with the affected toe eventually bending into a shape resembling a hammer or inverted “V”.
Because hammertoe is a progressive condition, it is important to recognize it and seek treatment as soon as possible. In the beginning, the deformity will be mild, but it will get worse with time unless there is some sort of intervention.
Hammertoes are classified into those that are flexible and those that are rigid. With those considered flexible, you can still move the toe. Rigid hammertoes, as the name implies, have reached the level of severity where the joint is pushed out of alignment, and movement is no longer possible.
Symptoms of a Hammertoe
Some of the more common symptoms of hammertoe include:
- pain in the affected toe, especially when bending it or while wearing shoes
- inflammation or redness
- burning sensation
- corns and calluses on the top of the affected joint
- abnormal shape due to contracture of the toe
- developing rigidity causing difficulty in movement
Hammer toe symptoms may be mild in the beginning, but it is important to address them early. In severe cases, there can be open sores, which invite infection, and total loss of flexibility, leading to the need for surgery.
Causes of Hammertoes
Hammertoes can develop from a wide range of causes. The tendency appears to run in families so genetics may be the cause. They can also be added to the long list of conditions that become more likely as we age. Some of the other common causes are:
- structural issues such as those with especially high arches, flat feet, or a second toe that protrudes beyond the big toe
- certain diseases like arthritis, diabetes, stroke, polio, and Charcot-Tooth-Marie, which causes nerve damage, are often associated with hammertoe,
- injuries or trauma
- spinal cord tumors
- pressure from a bunion, pushing the other toes out of alignment
- excessive alcohol use
One of the most common causes of hammertoes is improper or ill-fitting footwear. This is particularly true of shoes that are so narrow or tight that they squish the toes together in such a small space that they force the bones into unnatural positions. The primary example of this is women’s pointy, high-heeled shoes and is believed to account for the reason that women are much more likely to suffer from hammertoes than men.
Treatment for Hammertoes
Treatment for hammertoes will be based on the progression of the condition and whether the joint is still flexible or has advanced to the rigid stage. For flexible hammertoes, there are several options that are non-surgical, which emphasizes the need to make an appointment with your orthopedist as early as possible. Once the joint has become rigid, the non-surgical options will no longer be effective.
The most common non-surgical recommendations for reducing the pain and slowing or stopping the progression of the hammertoe include:
- taping or splinting the toe to keep it in proper alignment
- custom-made inserts to relieve pressure on the toe, which will reduce pain and keep the deformity from getting worse
- wearing shoes that are properly fitted, which should include
- the right size – helpful to shop later in the day when the feet have had a chance to swell
- adequate space in the toe area
- correction for issues like overpronation
Surgical Hammertoe Correction
If non-surgical options are unsuccessful, surgery may be the next step. Also, when the condition has reached the stage where the toe can no longer be bent and is classified as rigid, non-surgical methods will not be sufficient and your orthopedic surgeon will likely recommend surgery. The procedure will vary, depending upon the exact nature and severity of the condition, and should only require a local anesthetic. You will be able to go home the same day.
The most common surgical procedures for hammertoe correction are:
- Tendon lengthening – this is done when the joint still has some flexibility and involves lengthening the tendon or tendons that have created the imbalance.
- Tendon transfer – another option for those whose toe can still be bent is for the surgeon to transfer one or more tendons, usually from the bottom of the same toe, to the top, adding more strength in the effort to return the toe to a straight position.
- Arthroplasty – this is done by removing a section of bone from the joint so that the joint can bend.
- Arthrodesis – the goal of this procedure involves fusing the bones together. Once enough bone has been removed from the joint to allow it to once again fully extend, the bones will be held in place with pins, wires, or a plate so that the bones can fuse and hold the toe in a straight position.
Recovery from hammertoe surgery will take several months and will depend on the method used.