Hammer toe is the most common deformity of the second, third, or fourth toe. It is often caused by wearing narrow shoes with little to no arch support.
The condition can be extremely painful but there are many treatments available to ease the pain.
A hammer toe is a toe that has an abnormal bend in its middle joint, making the toe bend downward to look like a hammer.
This painful condition forms due to an imbalance in the surrounding muscles, tendons, or ligaments that normally keep the toe straight.
Hammer toes are flexible to begin with. If hammer toe is not treated promptly, they may become fixed and require surgery to correct them.
Hammer toe occurs from an imbalance in the muscles surrounding the middle toe joint. These muscles, tendons, and ligaments work together to bend and straighten the toes.
If one of the muscles weakens, it cannot bend or straighten the toe. If the toe stays bent long enough, the muscles tighten and the toe will not be able to straighten out.
These muscle weaknesses and imbalances are caused by a variety of factors. Because some of the causes for hammer toe are avoidable, it is possible to minimize risk of developing hammer toe.
Causes of hammer toe include the following:
- Certain shoes – wearing high heels or shoes that are too tight through the box can force toes into a flexed position. When worn repeatedly, the toes may not be able to straighten, even when barefoot.
- Sex – women are more likely to develop hammer toe than men.
- Injuries – When a toe is broken, stubbed, or jammed, it may be more likely to develop hammer toe.
- Age – risk increases with age.
- Toe length – if the second toe is longer than the big toe, hammer toe is more likely to occur.
- Certain diseases – people suffering from conditions like arthritis or diabetes are more likely to develop foot problems, including hammer toe
- Genetics – sometimes, hammer toe is hereditary and may run in families.
Due to footwear styles, women are more likely than men to develop hammer toe. The risk of hammer toe also rises with age.
The symptoms of hammer toe are often very visible. The affected toe will be bent, looking like a hammer.
Other symptoms of hammer toe include:
- Pain in the affected toe, especially when moving it or wearing shoes.
- Corns and callouses on top of the middle joint of the hammer toe.
- Swelling, redness, or a burning sensation.
- Inability to straighten the toe.
- In severe cases, open sores may develop on the toe.
A doctor normally diagnoses hammer toe during an exam. The doctor may gently move the foot and toe to cause symptoms to occur. This helps the doctor to thoroughly evaluate the condition of the toe.
Hammer toe is often very obvious in a foot exam. However, a doctor may order X-rays of the foot to further examine the bone structure of the affected foot.
Risk factors and complications
Hammer toes are progressive, worsening over time. If not promptly treated, the toe joint may become fixed and require surgery to straighten it.
The more a person with hammer toe wears improper footwear and the longer the person ignores the developing hammer toe, the more likely the toe will require surgery to release the tendons.
When to see a doctor
While not a medical emergency, hammer toe does worsen over time. It is necessary for people to see a doctor promptly after noticing any symptoms of hammer toe or other foot issues.
People being treated for hammer toe should also check with a doctor if they notice that the condition worsens or does not get better with prescribed treatments.
In very rare circumstances, a patient with hammer toe may develop sores on the top of the middle joint of the affected toe. These sores may become infected. If there is any sign of infection, including pus, redness in the skin around the sore, or fever, a doctor should be seen.
If hammer toe is caught early enough, it can be managed with some lifestyle changes and exercises.
Treatment for mild hammer toe
If the hammer toe is treated while the toe is still flexible, a doctor may recommend the following:
- Exercises such as picking up marbles with the toe.
- Switching to proper footwear with low heels and a roomy box.
- Gently stretching the toe manually several times a day.
- A podiatrist may be able to create a shoe insert to reduce pain and stop the hammer toe from worsening.
- Using over-the-counter corn pads and foot straps to relieve some of the painful symptoms.
- Sometimes a doctor might use a cortisone injection to relieve pain.
It is important not to pop any blisters that might occur on the foot as this can lead to infection.
Hammer toe surgery
If the hammer toe cannot be moved, a doctor may recommend surgery for the toe.
The surgery aims to reposition the toe, realign tendons, and remove deformed or injured bone. Often, surgery is carried out as an outpatient, so the individual can normally go home on the same day as the procedure.
Possible surgical procedures include:
- Arthroplasty – half of the joint under the crooked part of the toe is removed to help the toe straighten.
- Arthrodesis – similar to above, but the entire joint is removed and a wire or pin is inserted to help healing.
- Tendon transfer – tendons from under the toe are rerouted to above the toe to aid straightening. This procedure may be done in conjunction with other surgical interventions.
- Basal phalangectomy – for individuals with severe stiffness. The base of the bone underneath the toe is removed.
- Weil osteotomy – metatarsal bone is shortened and surgical hardware is inserted to aid healing.
Hammer toe, like many other foot problems, can be avoided with wearing proper footwear. Proper footwear should have the following:
- Low heels – higher heels force the feet into unnatural positions and often bend the toes.
- Enough toe room – shoes should be properly sized and pointy-toed shoes should be avoided. Shoes should accommodate for the longest toe, which may not always be the big toe.
- Adjustability – shoes with adjustable laces and straps are best.
- Proper arch support – arch support prevents a number of foot ailments.
Hammer toe can be treated and prevented with simple exercises and footwear changes. However, if the toe becomes rigid, surgery may be needed to relieve the hammer toe.
Even after treatment, hammer toe may return. The best way to make sure that hammer toe does not reoccur is through choosing proper footwear.