Hammertoe

What Are Hammertoes?

A hammertoe happens when the muscles and ligaments around your toe joint get out of balance. This makes the middle joint of your toe buckle and get stuck in this position. You’re most likely to see hammertoe in your middle three toes. Toes that curl are also hammertoes. This happens most often with baby toes.

There are two types:

  • Flexible hammertoes. If  you can still move your toe at the joint, it's a flexible hammertoe. That's good, because it means you have a  milder form of the problem. There may be several treatment options.

  • Rigid hammertoes. If the tendons in  your toe get rigid, they press the joint out of alignment. At this stage, you can’t move your  toe. It usually means you need surgery.

Hammertoe Symptoms

The main symptom of hammertoe is a toe or toes that look bent upward in the middle. Because of these buckled toes, you may have:

  • Blisters and calluses from where your toes rub against the top of your shoes

  • Pain in your toe joint where it meets your foot

  • Pain when you walk

  • Stiffness in the bent toes that gets worse over time

Hammertoe Causes and Risk Factors

The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammertoe can form. Muscle imbalance puts a lot of pressure on your toe's tendons and joints. This pressure forces your toe into a hammerhead shape.

Causes include:

  • Shoes that don’t fit.If your shoes are too tight, too short, or too pointy, they push your toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.

  • Arthritis

  • Alcoholism

  • Charcot-Tooth-Marie disease, a disorder that damages the nerves in your arms and legs

  • Spinal cord tumors

  • Polio

  • Stroke

  • High arches

  • Feet that rotate inward when you walk

  • Bunions

Your risk of getting hammertoes goes up with:

  • Flat feet

  • Genes: You may have inherited conditions or features that make your feet unstable.

  • Age

  • Long toe bones: If your second toe is longer than your first, it’s at a higher risk of hammertoe.

Women are more likely than men to get pain from hammertoes because of the types of shoes they wear.

Hammertoes can be a serious problem in people with diabetes or poor circulation because they have a higher risk for infections and foot ulcers. Custom orthopedic shoes may prevent these complications. People with these conditions should see a doctor at the first sign of foot trouble.

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Hammertoe Diagnosis

Your doctor should be able to tell if you have hammertoes by looking closely at your feet and asking you about your symptoms. If they want more detailed information about your foot and toe joints or bones, you may also get an X-ray.

 

Hammertoe Treatment

To relieve some of the symptoms of hammertoe, your doctor may suggest:

  • Roomier shoes that extend at least a half inch past your toes

  • Inserts or pads in your shoes that reposition your toes to relieve pain

  • Special exercises that stretch and strengthen your toes

  • Taping or splinting your toe to make it straight

  • Ice packs on your toes to relieve pain and swelling

  • Nonsteroidal anti inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to help with pain and swelling

  • Steroid injections in severely swollen or painful toe joints.  

If your hammertoe is severe, you may have surgery to correct it. It may be an option if your pain has gotten very bad, your toe is very rigid, or you have an open sore because of your hammertoe. 

There are several surgery options:

  • Arthroplasty. A surgeon takes half of the joint under each crooked toe so it can lie flat. 

  • Arthrodesis. A surgeon takes out the whole joint under your crooked toes and inserts a wire to help it straighten as it heals.

  • Tendon transfer. A surgeon attaches tendons under your toe to the top of your toe to help it straighten out. 

  • Basal phalangectomy. A surgeon takes out the base of the bone under your hammertoe.

  • Weil osteotomy. A surgeon shortens certain bones in your foot and then puts screws in them.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on June 12, 2020

Sources

SOURCES:

American Podiatric Medical Association.

American College of Foot and Ankle Surgeons.

UpToDate.

Mayo Clinic: “Hammertoe and mallet toe,” “Bunions.”

American Academy of Family Physicians: “Hammer Toe.”

Cleveland Clinic: “Clawtoes.”

Penn Medicine: “Hammer Toe Treatment.”

Medscape: “Hammertoe Deformity Treatment & Management."

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