The name Hammer toe
comes from the way the tip of the toe hits or hammers on the floor with each
step. The primary deformity seen in a hammer toe is found at the PIPJ (proximal interphalangeal joint) which is the first or more proximal of the two joints of the toe. A mallet toe, on the other
hand, is a similar deformity but is found in the DIPJ (distal interphalangeal joint). And lastly, claw toes are a deformity where the entire toe grabs and involves the MPJ (metatarsal phalangeal
joint) PIPJ and DIPJ. Collectively, these deformities are referred to as hammer toes. Hammer toes can affect one or all of the toes simultaneously.
Hereditary and shoe gear are probably the most likely reasons to develop a hammer toe. Tight pointy shoes may cause a hammer toes. High heels also can cause hammer toes. A deformed toe often develops
over time, and certain types of feet may be predisposed. Some patients may develop a hammer toe or cross over toe (of the 2nd toe) due to a bunion of the big toe.
Well-developed hammertoes are distinctive due to the abnormal bent shape of the toe. However, there are many other common symptoms. Some symptoms may be present before the toe becomes overly bent or
fixed in the contracted position. Often, before the toe becomes permanently contracted, there will be pain or irritation over the top of the toe, particularly over the joint. The symptoms are
pronounced while wearing shoes due to the top of the toe rubbing against the upper portion of the shoe. Often, there is a significant amount of friction between the toe and the shoe or between the
toe and the toes on either side of it. The corns may be soft or hard, depending on their location and age. The affected toe may also appear red with irritated skin. In more severe cases, blisters or
open sores may form. Those with diabetes should take extra care if they develop any of these symptoms, as they could lead to further complications.
Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems
to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your
doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.
Non Surgical Treatment
Many people start by treating the problem themselves when they have a painful corn or callus. They try to remove the corn by cutting it off or by applying strong acids, and they try to cushion the
toe by applying cushioned pads. Because these treatments can be difficult to perform by oneself (and should never be done by oneself when the patient is diabetic or circulation is poor), and because
these treatments only treat the symptom, not the structural deformity that causes their symptom, these treatments can often provide only limited success, and often any success is for only short
periods of time. Changes in shoe choices and various types of paddings and other appliances may help, too. For longer-lasting help, we must examine the cause of the deformity. The reason for knowing
the cause is that the type of treatment will vary, depending upon the cause of the complaint. Orthotics help control the causes of certain types of contracted toes, (those caused by flexor
stabilization, for example), but not other types.
Treatment of a severe hammertoe that has become rigid includes surgery. What is done during the surgery depends on how misshapen and inflexible the toe is. The surgeon may make a cut over your toe
and release the tendon by cutting the tendon away from the bone. The surgeon may remove a small piece of bone from the toe. The surgeon may realign the tendons to reposition your toe or fasten the
bones with pins. Sometimes the surgeon may have to join the bones in the toe. In this case, you
will no longer be able to bend the toe, but the toe will be flat.
The easiest way to avoid hammertoe is to wear shoes that fit properly. Orthopaedic surgeons and podiatrists recommend shoes that have roomy toe boxes, which give the toes plenty of space to flex.
Shoes that fit well should also cushion the arch in the middle of the foot. This helps to distribute the weight of the body evenly across the bones and joints of the foot. The size and shape of a
foot can change with age, and many people inadvertently wear the wrong size shoe. Podiatrists recommend having your feet measured regularly to ensure that your shoes fit properly.