Hammertoes

What is a Hammertoe?

A Hammertoe, Clawtoe, or Mallet Toe is a contracture (bending) 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 problems to develop.

Hammertoe2Hammertoes usually start out as mild deformities and get progressively worse (more bent and more rigid) over time.  In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures.  But if left untreated, hammertoes can become more rigid and will not respond to conservative treatments.

Because of the progressive nature of hammertoes, they should receive early attention.  Hammertoes never get better without some type of intervention.

Causes of Hammertoes

The most common cause of a hammertoe is a muscle/tendon imbalance.  This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.

Hammertoe1Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn.

Occasionally, hammertoes are the result of an earlier trauma to the toe.  In some people, hammertoes are inherited and in other people may develop a hammertoe or cross over toe (of the 2nd toe onto the great toe) due to a bunion deformity of the great toe.

Symptoms of Hammertoes

Common symptoms of hammertoes include:

  • Pain or irritation may develop on top of the toe(s), tip of the toe, and/or on the ball of the foot.  The pain is usually aggravated when wearing shoes.  
  • Corns and calluses (a buildup of hard skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction and pressure against the shoe. 
  • Inflammation, redness, or a burning sensation
  • Contracture of the toe
  • In more severe cases of hammertoe, an open sore (ulceration) may form due to the pressure on top of the bent joint rubbing in a shoe or at the end of the toe due to pressure as the end of the toe hits the floor.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the board certified podiatrists at Professional Foot and Ankle Centers will obtain a thorough history of your symptoms and examine your foot.  In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.  For your convenience, we are able to take any x-rays needed at both of our office locations.

Hammertoes are progressive – they don’t go away by themselves and usually they will get worse over time.  However, not all cases are alike – some hammertoes progress more rapidly than others.  Once we have evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatments For Hammertoes

There is a variety of treatment options for hammertoes.  The treatment selected for each individual patient will depend upon the severity of your hammertoe and other factors.  You may also visit our Website Foot Store for many options to help relieve the pain associated with hammertoes.

  • Padding corns and calluses. At Professional Foot & Ankle Centers we can provide or prescribe pads designed to shield corns from irritation.  
  • 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.  We fabricate custom orthotics built specifically for your foot at both the Davison and Lapeer office locations.
  • Injection therapy. A corticosteroid injection is sometimes used to ease pain and inflammation caused by hammertoes. When the contracted toe joint rubs in a shoe this can form bursitis of the joint and cortisone is very helpful at reducing this pain and inflammation.
  • Anti-inflammatory Medications. Prescription strength medicines (NSAIDS) to decrease pain and inflammation.
  • Splinting/strapping. Splints or small straps may be applied to realign the bent toe.  This can make your hammertoe feel better when wearing shoes, but this will never correct the deformity in a permanent fashion (the toe will always remain bent after the splint is taken off- no matter how long you wear the device).

When Is Hammertoe Surgery Needed?

Surgery is the approach that is often necessary to correct hammertoes that fail to respond to nonsurgical management.  Pads, medications and wide shoes can relieve a lot of pain associated with hammertoes, but sometimes these treatment options are not geared toward specific patient needs.  Wearing a pad daily is not very appealing for many patients, wearing a roomy shoe is not always an option for a professional that wears a dress shoe daily, and many times patients do not want to take an anti-inflammatory pill daily due to long-term risks associated with this medication.  While we can often relieve the pain of a hammertoe conservatively, no conservative treatment has been shown in studies to be effective at permanently straightening a hammertoe.  The only way to permanently straighten a hammertoe is through surgery.  So when your hammertoe is causing pain and you are looking for a more permanent solution to your problem, hammertoe surgery is an excellent option.  

How are Hammertoes Surgically Corrected?

There are many hammertoe procedures available and we will be able to discuss each of them during your consultation.  Some common hammertoe procedures we perform include the: digital arthroplasty, digital arthrodesis (fusion), tenotomy, capsulotomy, flexor tendon transfer, Weil osteotomy, exostectomy, phalangectomy and toe shortening procedures.

Often patients with hammertoes have bunions or other foot deformities corrected at the same time.  In selecting the procedure or combination of procedures for your particular case the board certified surgeons at Professional Foot & Ankle Centers will take an x-ray of your foot and perform a detailed examination of your foot.  We will also use several other factors to determine the best procedure(s) for you.  Some of these factors include: the number of toes involved, your age, your activity level, and typical shoes worn. 

What is the Typical Hammertoe Surgery Scenario?