Hammertoes

What is a hammertoe?

Hammertoe is a bending of one or both joints of the lesser digits (digits 2-5).  Hammertoes become a problem when wearing shoes because the abnormal bending can put pressure on the toe and cause painful corns and calluses.  Digital deformities are classed according to their flexibility, which changes over time becoming more rigid.  Once the deformity becomes rigid surgery may be the only option as far as treatment.  Hammertoes should be addressed early as they are progressive and never get better without intervention.

What causes hammertoes?

Although neuromuscular and congenital pathologies may contribute to lesser toe deformities, ill-fitting shoes along with the aging process are the leading cause.  The lesser toes contribute to balance and pressure distribution on the foot and when this delicate imbalance between muscles and tendons occurs, deformities such as hammertoes or claw toes can result.  A hammertoe may result if a toe is too long and becomes cramped when a tight shoe is worn.  With a severe bunion deformity the big toe shifts toward the 2nd digit causing the ligament on the bottom of the joint (plantar plate) to stretch out and exacerbate the hammertoe deformity.

Symptoms of hammertoes

These deformities are typically painful when the patient is wearing shoes.  The flexed tips of the toes can develop corns as well as on the top of the toe caused by constant friction against the shoe.  Inflammation and redness can also occur.  In patients with neuropathy like a lot of our diabetic patients, this can result in infection of soft tissues and bone. 

Diagnosis of hammertoes

During physical examination, the physician evaluates the flexibility of the deformity to determine a treatment plan because the surgical options vary based on whether the deformity is rigid or flexible (able to be reduced). Digital x-rays will be obtained in the office and will show the extent of the contracture.

Treatment of hammertoes

  • Conservative treatment

Roomy, well fitted shoes with a high toebox and a soft sole are the primary treatment.  Shoes with high heels or pointed toes should be avoided.  Protective pads or sleeves over the dorsal aspect of the toe can be applied to diminish pressure from the toebox of the shoe.  Over-the- counter medicated pads are not recommended because they may contain a small amount of acid that can be harmful.  Hammertoe slings attached to a metatarsal pad and taping of the MTP joint toward a neutral position also can be beneficial.  Corticosteroid injections as well as oral nonsteroidal anti-inflammatory medication are sometimes used to help with pain and inflammation.  Custom orthotics can also be made to help control the muscle/tendon imbalance; however there is no way to reverse the deformity.  This is a progressive deformity that will only become worse with time.

  • Surgical treatment

Surgery is typically needed when the hammertoe has become more rigid and painful.  The goal of surgery is to bring the toe into a corrected position, increase its function, and create a pain-free aesthetic result. When a flexible deformity becomes painful and assessed early enough early correction can be as simple as a soft tissue release. The best results occur when the deformed and contracted digit is fused along with a tendon transfer.  The digit is fused with wires or implants that are hidden within the digit and do not require later removal.  Following the surgery, the patient is weightbearing in a boot.