| Hammer Toe |
General Information |
Hammer toe, mallet toe, and claw toe are all deformities describing
bending or clawing of the toes. They are somewhat similar in appearance
but with subtle differences, hence the differences in the names. With
hammer toe, the affected toes give the appearance of a hammer. Differences
in hammer toe, claw toe, and mallet toe are caused by differences
in the direction and extent of the deviations in the joints of the
toe or toes that are affected. In hammer toe, the middle joint of
the toe is the one affected. |
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The cause of the condition is a tightening of the ligaments and tendons
of the toe, causing a buckling of the joint of the toe. The result
is a cocking of the toe upward, whereas in a normal foot, the toes
lie flat. Shoes can then rub on the top of the cocked toe, eventually
causing painful corns or calluses. If the deformities are not treated,
the toe may become permanently fixed and rigid. |
Causes of Hammer Toe? |
The main cause of hammer toe deformities is genetics. Symptoms can
be caused by wearing tight shoes or high heels that crowd the toes.
They may also be brought on by injury or by bunions pushing the big
toe against the smaller toes. |
Symptoms of Hammer Toe? |
There will be an obvious hammer-shaped deformity to the affected toe,
in addition to pain and a callus caused by the upper part of the
toe rubbing against the shoe. A corn or callus may also develop on
the tip of the toe from pressure and rubbing on the bottom of the
shoe. Patients may find it difficult finding shoes that do not cause
pain, and infections may develop as a result. Ulcers may develop in
patients with diabetes because of decreased sensitivity in the foot. |
Treatment |
All three conditions can be treated with conservative measures, if
the abnormal position is not rigidly fixed. These include: |
• Wearing shoes with soft and
roomy toe boxes (at least ½ inch longer than the longest toe)
• Avoiding high heels
• Stretching the upper
part of the shoe to help accommodate a fixed hammer toe
•
Strengthening toe muscles with exercises such as picking up marbles
with the toes and stretching exercises
• Wearing orthotics
• Wearing soft pads over the corns or calluses
•
Shaving of the thickened skin with a pumice stone or file
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If the hammer toe condition has become rigid (inflexible, fixed, permanent),
surgery may be required, with a goal of realigning the toe. Procedures
may include: |
• Cutting or lengthening tendons
• Transferring a tendon to another place
• Shaving
a small piece of bone from the prominent knuckle
• Insertion
of a steel pin to fix the corrected position of the toe
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In the case of surgery, a period of several weeks in an open-toed
surgical shoe that acts like a splint will probably be required. Surgery
can be done under local anesthesia with just one needle in our out-patient
ambulatory center. If desired, IV sedation can be given for those
who do not wish to be aware that anything is being done. Regardless,
you are usually on your way home 25-30 minutes after the procedure.
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