Hammertoe is a contracture deformity of one or both joints of the 2nd, 3rd, 4th, or 5th toes. This bending can put pressure on the toe when wearing shoes, causing a variety of symptoms to develop.
Hammertoes typically start out as mild deformities and get progressively worse over time. In the early stages, hammertoes are flexible and the symptoms can often be managed with conservative padding or taping measures. If untreated, as the deformity progresses hammertoes can become more rigid and will not respond to non surgical treatment.
Causes
Hammertoe is secondary to a muscle/tendon imbalance. The imbalance leads to a bending/contracture of the toe and eventually results in a mechanical change in the foot.
Often times hammertoes accompany bunions due a structural change of the foot. The great toe does not perform its intended function causing the lesser digits to take more weight than they are designed to take. As a result the digits contract due to the muscle/tendon imbalance.
Hammertoes can be aggravated by shoes that cause the toes to wedge/cramp in the toe box.
Symptoms
- Pain or irritation of the toe when wearing shoes.
- Corns and calluses on the toe, between toes or on the ball of the foot. Corns are secondary to constant friction against the shoe. Typically they are soft or hard, depending on their location.
- Inflammation, redness or at times a burning sensation.
- Contracture of the toe.
- In severe cases, open sores can develop.
Diagnosis
Hammertoes are usually promptly apparent due to the visible prominence and contracture. The surgeon will assess the reproducibility of your symptoms by moving/manipulating your forefoot as well as gently press on areas to determine any discomfort.
X-rays are usually ordered to determine the degree of the deformity and assess the changes that have occurred.
Due to the progressive (worsening) nature hammertoes do not go away and will continue to get worse over time. Despite the progressive nature some hammertoes are worse than others additionally some hammertoes never cause symptoms and/or discomfort. Thus, there is a variable degree of the symptoms as well as the pathology.
The goal of the surgeon is to create a treatment plan that is specific to the patients needs.
Non Surgical Treatments
Treatment approaches for hammertoes are based on how long the pathology has been present and the severity of the symptoms. Conservative treatment options are aimed at easing the pain of hammertoes, but again hammertoes are progressive and the treatment will not reverse the deformity.
- Changes in shoewear. Choose shoes that have a wider toe box, are not too short for the toes, and avoid pointed shoes or shoes that wedge the toes together.
- Padding. Pads placed over the area of the corns or calluses that have developed can help minimize pain. These can be purchased at a drug store.
- Splinting/Strapping/Bracing. Splints or small straps may be applied by the surgeon to realign or protect the bent toe. These can be purchased at a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including long periods of standing or long walks/runs.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Ice. Applying an ice pack to the area of discomfort throughout the dat helps reduce inflammation and pain.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help correct the underlying structure of the foot, stabilize motion, and control muscle/tendon imbalance.
Surgery
If non surgical treatments fail to relieve hammertoe pain, then the hammertoe becomes rigid, when the pain of a hammertoe interferes with daily activities, or when an open sore has developed surgery may be necessary. Your surgeon will select the best procedure to remove deformity and relive the pain associated with the hammertoe. Together with your surgeon consideration will be taken in regards to the extent of your deformity, number of toes involved, x-ray findings, your age, and your activity level. The recovery period will vary, depending on the procedure or other procedures performed.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing.