There are numerous painful foot problems, and one of them is hammer toe. It’s a joint condition that typically affects the second or third toe, although it can impact the fourth and fifth toe as well. This condition causes the middle joint (proximal interphalangeal joint) of the toe to bend upward, causing it to curve downward instead of pointing forward. This bending is abnormal and resembles the shape of a hammer. Hammer toe is a relatively common foot problem, with over 200,000 cases diagnosed in the United States annually.

What Causes Hammer Toe?

According to doctors and researchers, a muscular imbalance that puts extra pressure on the ligaments and tendons in the toes is the root cause of hammer toe. Wearing improper footwear is a common contributing factor, and high heels are particularly problematic. Age may also play a role as the muscles inside of the foot become weak and the muscles inside of the leg/calf become stronger. This muscular imbalance leads to the hammer toe deformity. If the deformity has been present for a long period of time, it becomes stiff and it cannot be fully corrected with simply trying to straighten the toe.

Symptoms of Hammer Toe

Although the most apparent symptom of hammer toe is the bending of the affected toe, there are other symptoms that can significantly impact a patient’s quality of life. Toe pain is a frequent issue, and patients may also have difficulty walking, standing or bearing weight, and experience discomfort when moving their toes or wearing shoes. The damaged toe can also develop calluses and corns, which can be painful. In severe cases the calluses can become thickened and lead to an ulceration and even a severe infection into the joint, jeopardizing the toe.

Diagnosing Hammer Toe

It’s relatively easy for physicians to diagnose severe and moderate hammer toe based on physical examination alone, without the need for imaging or other diagnostics. The doctor will assess the flexibility of the affected toe or toes and evaluate the foot to determine appropriate treatment options. However, in some cases, x-rays or other diagnostic images may be necessary to confirm the diagnosis. Some physicians may also use additional diagnostic tools to rule out other foot conditions.

How Do You Treat Hammer Toe?

Hammer toe is a treatable condition, and it’s usually simpler to treat if caught in the early to middle stages. Severe cases may require surgery with reconstruction of the toe and at times the next joint into the foot.

Non-Surgical Treatment Options

Initially, most physicians recommend wearing different footwear. Patients are typically advised to avoid high heels and shoes that restrict toe movement. Switching to shoes that allow the toes to wiggle can help correct the condition. Many doctors also suggest sizing up in shoes to provide ample wiggle room. In some cases, shoe repair shops can custom fit shoes to add more wiggle room for impacted toes while ensuring the rest of the shoe fits properly. Shoes with a taller toe box or front of the shoe prevents pressure on the toes leading to pain or even skin breakdown.

Over-the-Counter Aids

Cushions and orthotic devices can be used in shoes to make them more comfortable for patients. Many patients find these aids helpful in making exercising and walking more comfortable.

Surgical treatment may be necessary when the hammer toe becomes severe enough to cause severe pain and mobility issues. In some cases, the toe may no longer move, and surgery is needed to correct the condition. The specific surgical treatment required depends on the severity of the condition. Common surgical treatments for hammer toe include:

• Tendon lightening: This involves extending the tendons in the affected toe that are causing the joint abnormality to improve flexibility.
• Tendon Transfer: In this procedure, the surgeon transfers healthy tendon from the top of the toe to the middle to help straighten the toe and regain movement.
• Joint Fusion: This involves fusing the joints through a procedure called arthrodesis. The surgeon removes a small part of the bone near the toe joint to allow the toe to extend, then uses a metal implant or wire to connect the bones to the joint. The toe will eventually fuse, and the toe will be permanently straight. This option is usually reserved for severely affected toes with rigid joints.

Surgical treatment for hammer toe is typically an outpatient procedure, and recovery takes 4-6 weeks. Some patients may need physical therapy to regain strength and range of motion after surgery.

Preventing Hammer Toe

Although preventing hammer toe is not always possible, there are some ways to reduce the risk of developing this condition. It’s important to wear shoes that fit properly. Exercising your feet and performing toe-strengthening exercises can also help. Movements like extensions, curls, and splaying the toes can all be helpful in reducing the risk of developing hammer toe. Grasping a dish cloth or marble is a great exercise to strengthen the muscles inside of the foot that help keep the toes straight.

If you are experiencing discomfort due to hammer toe and seeking relief, Flint Foot and Ankle is available to provide assistance. We offer various treatment options, including surgical repair, depending on the severity of your condition.