A hammer toe is a toe deformity which causes bending of the toes at the knuckle joints. Along with claw toes and bone spurs, hammer toes are among the most common toe deformities. Most commonly, these affect the 2nd through 5th toes, and often develop calluses due to the increased pressure at the tip of the toes. In severe cases, redness, swelling, and even open sores can develop over time.
What Are The Causes of a Hammer Toe?
Hammer and claw toes can develop from genetics, poor shoe choices and other medical conditions.
Typically, people born with a certain foot shape may predispose them to hammer and claw toes. Flat feet, high-arched feet, or flexible feet are more prone to developing these problems. Hammer toes are sometimes caused or made worse by a bunion deformity involving the big toe. When the big toe starts to bend inwards towards the other toes, it may cause increased pressure on the second toe which pushes it upwards often causing a hammer toe.
Other causes for toe problems include longer toes, tendon imbalance, injury, rheumatoid arthritis, diabetes and neuromuscular disease. Over time, the mechanics of your foot and certain types of shoes can progress the deformities.
A hammer toe is marked by the toe joint being rigid and bent in an unnatural position. There may be pain radiating from the top of this toe or the balls of the feet. There may be redness, swelling, or decreased range of motion in the toe joints. Corns, calluses, blisters, and toe pain will often develop due to the friction of the toe rubbing in the shoe. This rubbing in the shoe may also cause the formation of a red, inflamed sac of tissue over the joints called bursitis.
Genetics and the natural shape of your foot are factors in the formation of hammer toes. There is a higher risk for those who have high arches, flat or flexible feet. Shoes that are too narrow, ill-fitting, or have high heels or pointed toes can also increase your likelihood of developing toe deformities. In some cases, hammer toes can be caused by injuries or by various health conditions such as rheumatoid arthritis, diabetes or neuromuscular disease.
A podiatrist can often diagnose a hammer toe with visual inspection and performing a physical and biomechanical exam. They will usually test for stiffness, reduced range of motion, or pain from specific motions of the joint. X-rays may also be used to make an accurate diagnosis.
When hammer toes and claw toes cause mild pain, the simplest solution is wearing wider, more accommodating shoes to decrease friction. Helpful changes to footwear may include smaller heels, softer material such as mesh and wider toe boxes. Cushions and various soft pads over the toes or insoles may provide relief from shoe pressure. You should avoid “medicated” corn pads over the toes, which contain a strong acid that can cause chemical burns or deep open sores that pose a high risk of infection.
Surgical options should be discussed with your podiatrist if hammer toes continue to be painful despite conservative therapy or if findina a pair of comfortable shoes becomes a challenge.
The longer surgery is delayed in a symptomatic foot, the greater the amount of deformity that may develop. Patients who have their symptomatic hammer toes and claw toes corrected earlier tend to have greater satisfaction and recovery after the procedure.
Surgery For Hammer Toe & Claw Toe
The goal of surgical correction is to restore normal alignment and function of the toe joint. Different procedures will be recommended depending on whether the toes are still flexible or if they have become rigid, or if a claw toe is present. Sometimes a small pin is placed inside the bones to hold the toe in a proper position while it heals. If a bone spur is the cause of the problem, this can be removed through a small incision often closed by one stitch.
Recovery from Hammer Toe & Claw Toe Surgery
Following surgery, the foot is bandaged and a post-operative shoe is worn for one week. Your podiatrist may recommend wearing athletic shoes after the first week. Weight bearing exercise and prolonged standing are restricted for the first 6-8 weeks. You may gradually resume activities and transition out of the surgical shoe once healing is complete.
One of the easiest ways to prevent development of hammer toes is to wear sensible footwear that doesn’t cause friction or strain to the toes. Avoiding high heeled shoes, flip flops and pointed toe shoes is recommended. There are daily exercises that you can do to help strengthen your muscles in the case the hammer toes are caused by a muscle imbalance. Regularly taking care of corns and calluses using a pumice stone or other treatments can alleviate pain and discomfort.
Initially, hammer toes are flexible and can be treated with simple measures. However, if left untreated, they can become rigid or stiff to the point where they cannot be straightened easily. As time progresses, pain may develop deep in the toe joints and the ball of the foot, limiting walking, exercise or even just standing comfortably. Ignoring early symptoms of hammer toes may cause the condition to worsen to the point where conservative treatments are ineffective and surgery is necessary.
Claw toes and bone spurs are other primary toe deformities which affect the lesser toes. Bunions may cause the big toe to drift inward, increasing the risk of these deformities.
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