Hammertoe - Abnormal Bending of Toe
Author: Dr. Yvonne Weber

What is Hammertoe?
Hammertoe is a contracture (bending) deformity of one or both joints of the second, third, fourth or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing pain, overlying skin changes and problems to develop.

Normal toes unaffected by hammertoeHammertoes usually start out as mild deformities and over time can get progressively worse. Hammertoes often start out as being flexible and then progress to being stiffer joint contractures with overlying skin changes.

Because of the progressive nature of hammertoes, they should receive early attention.

Causes for hammertoes include: A muscle/tendon imbalance, inherited long toe, trauma to toe, tight shoes, unstable shoes, neurological condition, joint degeneration, flat arches, bunion deformity causing instability and weight transfer.

Common symptoms of hammertoes include: Pain to the affected toe, Corns (a buildup of skin), between two toes or on the ball of the foot. Corns are caused by constant friction against the shoe. Joint inflammation. Redness. In more severe cases an ulceration or infection can form as a result of excessive rubbing in shoes or when walking.

The foot and ankle surgeon will examine your feet, watch you walk, examine your shoes, take digital x-rays to determine the degree of the deformities present. Hammertoes are progressive—they do not go away by themselves.Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is best for your life style and activities.

Nonsurgical Treatment
There is a variety of treatment options for hammertoe. A number of nonsurgical measures can be undertaken:
Padding corns and calluses: Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. Skin lesions may need to be addressed by your podiatrist with simple debridement techniques which can often provide tremendous relief. Do avoid medicated pads as they are generally not recommended because they may contain a small amount of acid that can be harmful.
Changes in shoewear: Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels-conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
Orthotic devices: A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. Injection therapy is often not recommended. Toe strapping techniques can help. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, often do not provide much relief.

When Is Surgery Needed?
In some cases, when conservative treatment efforts fail to provide relief, surgery may be necessary.

Often, patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination of procedures for your condition, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, your shoe choices, and other factors. Recovery time form surgery will vary, depending on the procedures performed.