What Are Hammertoes?

A hammertoe refers to a podiatric condition in which the toe has an abnormal bend at the proximal interphalangeal joint, which is the middle joint of the toe. When viewed from the side, the toe forms the shape of an upside-down V. The condition can affect any toe, although the second through fifth toes are most commonly affected. Females are more likely than males to experience hammertoes.

At first, a hammertoe may remain flexible. Over time, however, the tendons in the toe can tighten, causing a permanent bend in the toe. This can result in poorly fitting shoes, as well as pain and irritation on the toe or between toes due to friction from the shoes.

Hammertoe is a toe deformity that often starts out mild, but can worsen over time without treatment. Individuals who have developed a hammertoe should see a foot and ankle specialist and take steps to correct the condition before it worsens.


Hammertoe Causes and Symptoms

Hammertoes are caused by an abnormal balance of the toe muscles, or conditions that force the toe to flex or bend downward. This abnormal balance can be the result of a traumatic toe injury, arthritis, pressure from a bunion, or an usually high foot arch. Hammertoes can also be hereditary and often become worse over time due to arthritis or ill-fitting shoes. Wearing shoes that are too tight or that pinch the toes together may also cause hammertoe. This commonly occurs with shoes with high heels or narrow toe boxes.

The prevalence of hammertoes increases with age. Flat feet or tightness in the calf muscles may also increase risk of hammertoes.

Symptoms of a hammertoe may include:

  • Pain on the top of the toe, which may worsen with pressure or shoe rubbing.
  • Redness and swelling of the toe joint.
  • Rigidity of the toe or painful motion of the toe joint.
  • Formation of corns or calluses on top of the joint.
  • Pain on the tip of the affected toe.
  • Difficulty walking.

With severe hammertoes, open sores may form on top or at the tip of the affected toe.


Forms of Hammertoes

A hammertoe can be considered flexible or rigid.

A flexible hammertoe is a milder form of the condition and can still be moved at the joint. Many treatment options exist for flexible hammertoes.

Rigid hammertoes refer to more severe cases in which the toe can no longer bend. Surgery is typically required for rigid hammertoes.


Hammertoe Diagnosis and Treatment

A hammertoe can usually be diagnosed by a podiatrist during a physical exam. Occasionally an X-ray may be necessary to evaluate the condition.

The severity of the hammertoe will determine the proper course of treatment. Mild cases of hammertoes can often be addressed with conservative treatment and by wearing the correct shoes.

Individuals who wish to prevent hammertoes or improve on an existing condition should:

  • Avoid shoes with heels more than two inches tall.
  • Choose shoes with a deep toe box that extends at least half an inch past the toes.
  • Avoid shoes that are too tight or too narrow.
  • Have children’s shoes fitted properly and buy new shoes when they become tight.
  • Use orthotic inserts or pads in shoes to relieve pressure.
  • Use tape or a splint to keep the toe straight and correct muscle imbalances in the toe.
  • Stretch regularly to reduce the progression of hammertoes.
  • Use ice to relieve pain and swelling.
  • Take anti-inflammatory, over-the-counter medication such as ibuprofen.
  • Ask a foot and ankle specialist about custom shoe inserts, which can help position their feet and toes properly.

More severe hammertoes often require medical intervention, which may include surgery. Several surgical procedures can be used to correct hammertoes. For less severe cases, surgery can remove the bony prominence and restore alignment in the toe joint. More severe cases may require more complex surgical intervention. Swelling and discomfort may be present for several weeks following surgery and can be managed with medication.

Feet are not supposed to hurt. Individuals who are experiencing pain in their toe joints, difficulty walking or pressure from their shoes should consult a podiatrist about options for hammertoe prevention and treatment.

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