A hammer toe is a potentially painful deformity of the second, third, or fourth toes, where the toe bends upward at the joint, resembling a hammer.
When a hammer toe causes pain, and other treatments fail, surgery may be the only option for correcting the joint.
A hammer toe causes the toe to bend at the first joint, which is called the proximal interphalangeal joint. The problem usually begins with a muscle imbalance.
When a muscle gets too weak, it can put pressure on the tendons of the toe. This can eventually cause the joint to become deformed. People with hammer toe may also develop corns or calluses at the top of the joint from the toe rubbing on poorly fitted shoes.
Wearing ill-fitting or pointy-toed shoes is one of the most common causes of a hammer toe. High heels can also cause the condition, because the heel pushes the front of the foot down, forward, and against the shoe. Over time, the toe muscles grow weaker and are no longer able to straighten the toe.
Certain risk factors increase the likelihood of developing hammer toe. People with unusually long toe bones, a history of toe injuries, and rheumatoid arthritis are more at risk of developing hammer toe.
The type of hammer toe determines treatment options. There are two distinct types:
Flexible hammer toe
In the early stages, the joint is still movable. It is possible to treat flexible hammer toe without surgery, often by simply switching to better shoes.
A person can reduce the symptoms of a flexible hammer toe by avoiding high heels and wearing loose shoes that are at least a half-inch longer than the longest toe.
Toe-strengthening exercises, such as picking items up off the floor with the toes, may also help. Ice packs to reduce pain and swelling can help with pain and inflammation. A doctor may also recommend putting a pad over the joint to prevent it from rubbing against shoes.
Rigid hammer toe
A rigid hammer toe means the joint is no longer movable. Home treatment and better shoes may offer temporary relief from the pain, and a doctor may recommend trying a custom orthotic device before surgery. If that fails, surgery might be the only option.
Hammer toe surgery can be highly effective in people for whom the primary or only issue is hammer toe.
But when an underlying condition such as rheumatoid arthritis causes a hammer toe, doctors may recommend treating that condition first.
Surgical options for hammer toe include:
A tendon transfer pulls the toe into the correct position and often works well for a flexible hammer toe.
Tendons attach muscle to bone. During a tendon transfer, the surgeon pulls a tendon near the hammer toe across the top of the joint. This pulls the toe into a straighter position, compensating for muscle weaknesses and improving the toe's appearance. It should also reduce pain.
Joint resection can help with a fixed hammer toe. For this surgery, a doctor cuts ligaments and tendons to help straighten the toe and may also remove a portion of the bone.
To keep the toe in place, the surgeon may insert temporary pins. These pins can be removed a few weeks after the surgery.
A fusion procedure can reduce the severity of a fixed hammer toe. In this procedure, the surgeon removes portions of the joint to allow bones to grow together. This straightens the toe and can help reduce pain.
A surgeon will cut tendons and ligaments, as well as the ends of the bones. Then, the surgeon will use pins to help keep the joint in place. The pins remain in place to allow the bones to grow together and are removed after the joint has fused.
In rare cases where a person experiences severe pain from a hammer toe and no other treatment works, a podiatrist or orthopedic surgeon might recommend removing the toe. This is called amputation.
A 2005 study of 12 older adults who had toes amputated found that the procedure could alleviate pain, and people were typically very satisfied with surgical outcomes.
Removing a toe can change the way a person balances on their foot. It also permanently changes the foot's appearance and can be riskier and harder to recover from than some other surgeries.
Hammer toe surgery is primarily done on an outpatient basis. This means a person may go home the same day the surgery is performed.
Surgery can often be done with a local anesthetic that only numbs the toe, so the person remains awake during the operation. This can shorten recovery time and avoid the rare complications that sometimes accompany general anesthesia.
Hammer toe surgery can also be done under general anesthesia. People should discuss the risks and benefits of each option.
If a person is squeamish, does not want to see the procedure, or has a phobia of knives or needles, they might prefer general anesthesia. People with a history of bad reactions to general anesthesia or who want the shortest possible recovery time might prefer a local anesthetic.
Before surgery, a doctor will likely perform blood work and ask the person about their medical history. Some people will receive intravenous (IV) medication before or during surgery. An IV can be used to administer anesthesia or to provide a drug that helps a person feel relaxed while awake.
Under local anesthetic, a person will not be able to feel the procedure itself, but they may feel pressure or pulling. The surgery should not hurt.
After surgery, a person will typically feel some pain in the toe and must have someone drive them home. Those who choose general anesthesia may not be allowed to eat before surgery.
Following surgery, most people experience swelling, which can last up to a year. It may be necessary to wear a special shoe or a shoe insert to support the toe following the procedure.
A person will need to avoid putting weight on the foot for several weeks. Elevating the foot can speed up healing and reduce pain.
As the toe heals, walking can be difficult and painful, so a person may need a cane or crutches for a few weeks. They may also be unable to drive for several weeks.
A few weeks after surgery, the doctor will remove any stitches or pins. The incision will probably leave a scar.
Exercises to improve strength in the toe and foot muscles may help the toe heal. These exercises can also prevent hammer toe from coming back.
A person with a history of hammer toe is at risk of developing it again, even after surgery, so it is important to wear comfortable shoes that fit and to follow a doctor's recommendations for protecting the joint.
Hammer toe can be unsightly and painful, but it does not always require surgery. Home treatment, including changing shoes and toe exercises, often work.
An orthopedic surgeon or podiatrist can help a person correct the problem before surgery becomes necessary, so anyone experiencing symptoms of hammer toe should speak to their doctor before allowing it to get worse.