Hammer Toes

Hammertoes are deformities of the feet that affect the second, third, or fourth toe. The affected toe bends from the middle joint in such a way that it resembles a hammer. This disorder results from an imbalance between the weak intrinsic muscles and the stronger extrinsic muscles that surround the MTPJ joints of the lesser digits.

Many people tend to overlook this foot condition without realizing how important the lesser digits are in the pressure distribution and balance of the foot. Hammertoes can be distinguished into three categories, including classic hammer toe, mallet toe, and claw toe. A thorough clinical evaluation of the patient is of the highest importance when aiming for desired outcomes.

The symptoms of hammertoes are normally very visible as the affected toe becomes bent, looking like a hammer. It is typically characterized by chronic pain that is exacerbated by shoewear and ambulation. Symptoms tend to gradually increase as the deformity progresses. Besides the appearance of the affected toe, a hammer toe often causes added foot pain.

You may develop additional symptoms, such as:

• Toe pain
• Corns or calluses
• Swollen feet, especially near the toe joint
• Redness
• A burning sensation, which may be due to a diabetic foot problem
• Ball of foot pain
• Restrictive movement in the affected toe
• Open sores

There is a multitude of hammer toe causes. The reasons for this type of foot deformity are quite multifactorial, including acquired and congenital. Shoes are the main trigger for developing hammertoes. Shoes that are pointed, narrow, and tight cause the toes to crowd together instead of remaining flat. Over time, your toes stay in that bent shape even when you walk around barefoot, resulting in a deformity. High heels can cause foot injuries, but shoes that cramp your feet are especially harmful for flat feet.

Wearing high heels or poorly fitting shoes can lead to problems beyond hammer toes, such as:

• Achilles tendonitis
• Ingrown toenails
• Even a sprained ankle

Some of the most distinguishing causes of hammer toes are:

• Diabetes
• High heels and poorly fitting shoes
• Inflammatory arthropathies
• Intrinsic muscle imbalance
• Bunions
• Neuromuscular conditions
• Long metatarsals

When you visit our podiatrist, he checks your problem toe. The examination includes manipulating your foot to see how your toes react. If your toes don’t flex well enough and you’re feeling pain, your condition may need more aggressive hammer toe relief procedures. Only a qualified podiatrist like Dr. Petkov can decide.

During your exam, it will be beneficial to retrieve diagnostic imaging to make sure there aren’t any other problems. You may have stubbed, jammed, or broken a bone in the toe, which caused the deformity. Foot or ankle fractures can force you to walk differently. You may also have toe bone spurs that are creating additional toe pain.

The two most common diagnostic imaging tests used during an examination are:

• Magnetic Resonance Imaging. It may be helpful in case there is a sign of a plantar plate rapture. This advanced diagnostic technique can assist in determining the defects of the cartilage.
• Radiograph. It may be used to examine contractures and evaluate the relative metatarsal length. This type of imaging is particularly helpful during the pre-operative assessment.

Simply switching shoes may help, especially if your hammer toes are in the early stages. Wear shoes that have a wider box around your toes. Always buy shoes that have a half-inch of leeway between your toes and the tip of the shoes. In case conservative treatments were to no avail, surgical correction of a hammertoe is the only effective option.

Conservative Treatment

Before the surgical route is considered, various conservative treatments should be attempted. Patients are normally recommended to use shoes with a wide toe box to relieve pain and accommodate the deformities. High heels are forbidden because of the increased pressure on the forefoot.

Your doctor may also advise tapping or strapping the deformities that can potentially improve some alignment. These techniques are believed to be effective for addressing forefoot deformities. However, none of them are permanent solutions to hammer toes.

Other less invasive techniques for getting hammer toe relief include:

• Wearing orthotics in your shoes to relieve the pressure
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen that help reduce pain and inflammation
• Padding for corns and calluses, if present, to keep from aggravating them further
• Splinting to straighten your toe
• Specialized exercises involving bunching up a towel with your toes or trying to pick up small marbles with your toes — both exercises stretch out your toe muscles
• Physical therapy to help stretch and strengthen your toe muscles

Surgical Treatment

Surgical intervention might be the only option if the flexion contractures start forming and becoming constant along with pain. To correct flexible hammer toes, soft tissue release is typically employed. This procedure will maintain the structural stability of the toe. If you are dealing with a fixed hammer toe deformity, PIPJ arthrodesis or PIPJ resection arthroplasty may be used.

There is a wide variety of factors that increase your risk of hammertoes, including:

• Age. As you get older the risk of getting exposed to this foot disorder increases.
• Toe Length. You are at a higher risk if your second toe is longer than your big toe.
• Gender. Women are more likely to develop a hammertoe than men.
• Underlying health conditions. Arthritis, diabetes, and gout make you more vulnerable to a hammer toe deformity.

Hammer toes normally start as mild deformities that become worse over time. During your initial appointment at our podiatry clinic in NJ, Dr. Pektov will explicitly disclose all the potential complications and how they can affect your life.

Some of the most common and well-known complications include:

• Gait imbalance
• Severe pain
• Skin changes like corns and blisters
• Decreased quality of life

According to the research, published on NCBI, the overall prognosis of a hammer toe deformity is good. The rate of recurrence is ranging up to 10%. It has been found that people that showed a greater transverse deformity pre-operatively experience a greater failure rate than those whose deformity is mainly in the sagittal plane. Recurrence tends to occur because of the tight flexor tendon or inadequate bone resection.

As mentioned above, a hammer toe is arguably the most common foot condition that affects millions of people worldwide. According to a survey published by the Institute of Preventive Foot Health (IPFH), nearly 3 percent of U.S. adults aged 21 and older are dealing with a hammer toe deformity. This accounts for almost 7 million U.S. citizens.