There are two types of hammertoe
. Flexible hammer hammertoes
toes. If the toe
can still be moved at the joint, it's a flexible hammer toe
. That's good, because this is an earlier, less-severe form of the problem. There may be several treatment options. Rigid hammer toes. If the tendons in the toe
become rigid, they press the joint out of alignment. At this stage, the toe
can't be moved. This usually means surgery is required to correct the problem.
results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe
is bent and held in one position long enough, the muscles tighten and cannot stretch out. Shoes that narrow toward the toe
may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe
. Eventually, the toe
muscles become unable to straighten the toe
, even when there is no confining shoe.
A soft corn, or heloma molle, may exist in the web space between toes. This is more commonly caused by an exostosis, which is basically an extra growth of bone possibly due to your foot structure. As this outgrowth of excessive bone rubs against other toes, there is friction between the toes and a corn forms for your protection.
The exam may reveal a toe
in which the near bone of the toe
(proximal phalanx) is angled upward and the middle bone of the toe
points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe
beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe
is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe
boxes is enough to resolve the condition, while in more severe or longstanding cases podiatric surgery may be necessary to correct the deformity. The patient's doctor may also prescribe some toe
exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor. While watching television or reading, one can put a towel flat
under the feet and use the toes to crumple it. The doctor can also prescribe a brace that pushes down on the toes to force them to stretch out their muscles.
If conservative treatments fail and your symptoms persist, the doctor may recommend a surgical option to straighten the toe
. The procedures used vary greatly, depending upon the reasons for the hammertoe. There are a number of different operations to correct hammertoes, the most common ones involve Soft tissue corrections such as tendon transfers, tendon lengthening, and joint capsule
repairs. Digital arthroplasty involves removal of bone from the bent joint to allow the toe
to straighten. The temporary use of pins or K-wires may be necessary to keep the toe
straight during the healing period. Joint implants are sometimes used to allow for a better range of motion in the toe
following surgery. Digital arthrodesis involves the removal of bone from the bent joint and fusing the toe
in a straight position. If the corn is due to a bone spur, the most common procedure used is an exostectomy, in which surgically removing it or filing it down removes the bone spur. Because of the possible complications involved with any surgery, one should be sure to understand the risks that may be involved with surgery to correct hammertoes and remove bone spurs.
To help prevent hammer toes from developing, wear shoes or boots that provide sufficient width in the toe
box to ensure minimal compression. Use inserts that help the toes flatten out and spread and give sufficient support to the metatarsal arch in the forefoot. If hammer toes have already formed, padded socks help protect the tops and the tips of the hammer toes and may reduce pain from rubbing and chafing.