Hammer Toe

Your forefoot is made up of 4 phalanges (smaller toes) and 1 hallux (big toe). Your phalanges have 3 bones as well as 3 joints (MTP - nearest base of foot, PIP joint - middle, and DIP joint - tip of toe); your big toe only has 2 bones and joints. Your midfoot (metatarsal bones) and hindfoot (tarsal bones) make up your foot arches, instep, heel and ankle; these are responsible for weight bearing and propulsion. Your arches contain bones, ligaments, muscles and tendons of your foot, which require a lot of stability and flexibility.

Hammer toe makes your toes bend and look like a hammer. It causes your MTP joint to bend up and your PIP joint to bend down. This normally affects your second toe; however it can affect any of your small toes. It can be flexible (joint has ability to move) or rigid (joint has limited and/or no ability to move). Failure to treat it can breakdown tissues which affect the way you walk and lead to serious toe, foot, knee, or hip ailments, and/or infection. Hammer toe is among the most common toe deformities. Both men and women are at risk; however women are 5 times more likely to experience it than men. Also, the chance of suffering from hammer toe increases by 2 - 20% with age.

Causes

If you have hammer toe your flexor digitorum longus muscle (on bottom of toes) is often stronger than your other muscles; which creates an imbalance (your weaker toe muscles are overpowered). It exerts more tension on your foot which pulls your normal foot arch down - creating a flatter and longer foot.

Inappropriate footwear (short, tight, narrow, pointed, or high heels) puts pressure on your feet and keeps your toes in an unnatural, bent position. Wearing this type of shoe for long periods of time prevents your muscles from straightening your toe even when not wearing shoes. Often corns or calluses (hard growths of dead skin) or bunions (enlargement of bone or tissue on big toe) will develop around these pressure points from rubbing against shoes, which initiates hammer toe.

Conditions from birth, hereditary characteristics or abnormal toe bone lengths Muscle, nerve and joint damage from osteoarthritis, stroke, neuromuscular diseases (multiple sclerosis, Charcot-Marie Tooth disease, cerebral palsy, degenerative disc disease), inflammatory diseases (rheumatoid arthritis, psoriasis) or diabetes, poor blood flow to your feet (peripheral arterial disease)

Previous toe injuries, dislocation of toe joints or poor foot mechanics.

Excessive weight and activity levels

Symptoms

You will often have constant pain in your toe when moving it as a result of corns, calluses, bunions or blisters; generally found on the top, tip or base of your toes. The discomfort from this and cramping in your toes can radiate to your entire foot and lower leg, and can lead to posture and balance changes (affecting the way you walk).

Other hammer toe symptoms:

• Inflammation, redness and swelling in toe joints, synovial membrane (connective tissue and fluid which lines joint cavity), and bursa (fluid filled sac between tendons, ligaments and bones preventing friction)
• Deformed nails
• Infections or ulcers in toes
• Pigment discoloration

Diagnosing Hammer Toe

Your doctor will take your medical history and will examine your foot and toe for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray (check for arthritis or bone and joint inflammation) or blood tests (rule out diseases or infections) may be requested.

Treatment and Prevention

Early diagnosis and proper treatment are important, however hammertoe can be difficult to prevent as symptoms often start long after you¹ve had the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive areas. If your hammertoe is flexible, you can often manually straighten your toe. If your hammertoe is rigid, extra stress at the ball of your foot prevents your toe from straightening; you may require more extensive treatment. Failure to see improvements after conservative treatments may make surgery your only option.

Ultrasound is an excellent tool to reduce pain and inflammation when treating hammer toe. The application of ultrasound over the affected toe and foot area reduces swelling, increases blood flow, decreases pain, relieves tension making muscles and tendons more flexible, minimizes scar tissue, and helps tissues heal more quickly. It can be performed at home easily and safely with a portable ultrasound device.

Other conservative treatments:

1. Properly sized, adjustable, low-heeled footwear provide room and comfort (leave a 1/2 inch space between longest toe and inside of shoe); avoid super-snug stockings, nylons and socks


2. Footwear made out of breathable and flexible materials help prevent against corns, calluses and bunions (avoid vinyl or plastic materials)


3. Gentle foot massage after vigorous activities or long periods of standing help relax tissues; physical therapy, foot manipulation and reflexology are good for severe cases


4. Cushioning or supportive items, such as straps, non-medicated felt pads, moleskin, splints, toe shields or caps, protect and reposition your toe, and relieve pressure pain


5. Exercises that stretch and strengthen your foot muscles and tendons keep your muscles balanced


6. A healthy diet especially if you have diabetes (more prone to poor circulation and lack of feeling in your feet) keeps your body healthy


7. Corrective footwear, orthotics or other foot devices provide support and alignment (check to see if you wear out the soles of your shoes on one side)


8. Soak your toes in alternating warm and cold water baths; gently rub your corns or calluses with a pumice stone or nail file while your feet are in warm water

Toe surgery (tenotomy, tendon transfer, arthroplasty, or arthrodesis) helps to straighten your toe joint in severe cases when the soft tissues in your toes become very stiff and don't move at all. However, surgery is not always effective; it may improve the look of your foot, however there's no guarantee the problem won't come back after surgery.

Recovery from hammer toe can take between 4 weeks - 6 months, depending on the severity of your condition and your commitment to proper rehabilitation. The more dedicated you are with your treatments, the faster you will see successful, long-lasting results.

See Toe Deformities for more detailed information.