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What is Hammer Toe?

Hammer toe is caused by an inherited muscle imbalance or abnormal bone length. It may occur in children who outgrow their shoes rapidly. In this condition one or more small toes buckle when the middle joint (the PIP joint) contracts. This causes the tendons to shorten.

A foot with a bunion will often have a hammer toe also. Over time, the bunion slants the big toe toward and then under the second toe, the most frequently 'hammered' toe. This forces the second toe to rise into a claw-like position.

A hammer toe can lead to severe pain and pressure. Like claw toe, it creates extra stress in the ball of the foot, often leading to the development of corns and calluses.

Causes of Hammer Toe

The main cause of hammer toe is wearing tight shoes that crowd the toes, or high heels. It may also be brought on by an injury.

The cause of the condition is a tightening of the ligaments and tendons of the toe, causing a buckling of the joint of the toe. The result is a cocking of the toe upward, whereas in a normal foot, the toes lie flat. Shoes can then rub on the top of the cocked toe, eventually causing painful corns or calluses. If the deformity is not treated, the toe may become permanently fixed and rigid.

A hammer toe may also develop because of:

  • A deformity of the foot that is present at birth, causing tight tendons in the affected toe
  • A congenital misalignment of bones in the arch of the affected foot
  • Failing to replace the shoes of children whose feet have outgrown them
  • High heels and other restrictive shoes
  • Joint inflammation, such as that caused by arthritis
  • Damage to the muscles and nerves of the foot from a long-term disease like diabetes
  • An injury

Symptoms of Hammer Toe

Besides pain and its claw-like appearance, symptoms of hammer toe include:

  • Changes in gait and balance
  • Redness and swelling on and around the affected toe
  • Corns or calluses where the toe bends and rubs
  • Infections may develop
  • Ulcers sometimes develop in patients with diabetes, who have decreased sensitivity in the foot
  • It may be difficult to find shoes that accommodate the deformity

Hammer Toe Treatment

Treatment for hammer toe can be as simple as having the corn that has developed on the toe trimmed by a doctor to relieve pain and swelling. If a bunion is present, that condition may require specific treatment. Other recommendations may include:

  • Regularly using a pumice stone on calluses
  • Wearing shoes or sandals that give your toes plenty of room
  • Using protective padding on the hammer toe to prevent irritation
  • Wearing special shoes that conform to the shape of the foot and support the hammer toe, making it more comfortable to walk
  • Wearing shoes or shoe inserts (orthotics) that correct the hammer toe
  • Wearing soft pads over the corns or calluses
  • Strengthening toe muscles with exercises such as picking up marbles with the toes and stretching exercises

If the hammer toe has become is rigidly fixed in an inflexible position, surgery may be required. The goal of hammer toe surgery is to realign the toe and improve function or to lengthen the tendons by removing part of the proximal phalanx in older patients. Procedures may include:

  • Releasing a tendon that is too short
  • Transferring a tendon to another place
  • Insertion of a steel pin to correct the position of the toe

If surgery is required, a period of several weeks in an open-toed surgical shoe that acts like a hammer toe splint will probably be needed.

Living with Hammer Toe

Any change to one part of the foot significantly affects habitual ways of walking and standing. Left untreated, foot ailments such as claw toe, hammer toe, or mallet toe may produce problems in other weight-bearing joints, such as the hips or knees.

Any forefoot problems causing pain or discomfort should be given prompt attention. People who experience problems with their feet should seek advice from an experienced physician or podiatrist who can evaluate the risks, benefits, and possible complications of various treatment options. Patient compliance is particularly important in the treatment of these conditions.

Ignoring the symptoms of deformities of the toes can aggravate these conditions and lead to a breakdown of tissue, or even infection. Conservative treatment starts with accommodating the deformity. The goal is to relieve pressure, reduce friction, and transfer force from the sensitive areas. If surgery is recommended, it is important to fully understand and follow the recommendations of the surgeon before and after the procedure.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

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