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Hammertoe

Hammertoe is a bending or contracture of one or more joints in the little toes. Because the abnormal bending in the toes increases pressure under the ball of the foot and the top of the toes, this can cause pain. Many people with hammertoes have a great deal of difficulty fitting into shoes because the top of the shoe rubs on the top of the toe joint.


Hammertoe Symptoms

Pain

Pain or irritation of the toes that may turn red, develop painful calluses, or even open sores over the knuckles in the toes when rubbing in and irritated by shoes. 

Crooked Toes

Because they hammertoes continue to get more and more contracted, they can become contracted and crooked , making it difficult to fit into shoes.

Painful Corns

Painful corns most often develop on the top of the first knuckle (known as the proximal interphalangeal joint). Painful corns can also form between the toes where two crooked toes rub together. Corns are thickened areas of skin caused by repeated friction or rubbing on the inside of the shoe. Corns related to hammertoes may be soft or hard. 

Open Sores

Open sores (known as ulcers) may also develop because of hammertoes.  This is most common in people that have rheumatoid arthritis, diabetes, or neuropathy.  Although it seems like a small problem, these can lead to dangerous infections.  If those infections last for long enough, a bone infection can also develop.  In a number of cases, these bone infections actually lead to amputation. Corns and calluses seem to cause the most amount pain and people that have hammertoes.  This is usually worse in the wintertime when people have to wear, enclosed shoes continually.  Although corns and calluses can cause most of the pain related to hammertoes, many people get pain without corns because the joint is disrupted or becomes dislocated.  When the toe is contracted in an abnormal position like a hammertoe, this puts an enormous amount of stress on the joint supporting structures. This can lead to significant pain in the ball of the foot or in the toes themselves.

 

What Causes Hammertoe Deformity?

In many cases hammertoes are inherited. They can also be caused by injuries, such as fractures (broken toes) or dislocated joints in the toes. Hammertoes are usually caused by an imbalance between the muscle groups in the foot and leg. If the joint supporting structures are destabilized, the toe can become contracted.  This is very common in people with rheumatoid arthritis. It is also common in people with diabetes.  Hammertoes most often start out as relatively mild deformity, but will usually worsen over time. Without some sort of treatment, hammertoes will always continue to get worse. This may happen slowly, or it may happen quickly depending on the circumstances. Hammertoes never simply go away without some kind of treatment.

 

Non-surgical Treatment of Hammertoe Deformity

There are many simple treatments for hammertoes and the pain related to them. The most common treatment for hammertoes is to use a corn pad on the top of the toe to prevent irritation from the inside of the shoe. There are also a number of toe alignment splints that can help hold the toes in the correct position and prevent them from getting worse.  You should never use medicated corn pads without a doctor’s advice.  We see many patients that use these medicated pads who develop open sores, infections and a substantial amount of irritation. In many cases, simply trimming down the painful corns and calluses can reduce a person’s discomfort.  Trimming callouses and corns should always be done by a podiatrist. You should never attempt to trim corn or calluses. Doing so can lead to cuts and infections. Your podiatric surgeon has the most training of any practitioner when it comes to removing corns and calluses. Orthotics can also help to prevent hammertoes from becoming worse by stabilizing the foot and help them to correct muscle/tendon in balances in the foot. In many cases simply changing the types of shoes do you wear any help.  It is important to make sure that you have the right type of shoes to accommodate your foot structure. Corticosteroid injections can also sometimes be used to decrease the amount of pain and inflammation associated with hammertoes. In some cases, non-steroidal anti-inflammatory medications (NSAIDs) are helpful to reduce the inflammation as well. Splinting and strapping on the toes can also be performed by your podiatrist in order to hold the toes in alignment.  Many times this is an effective treatment which can be used to decrease the pain and symptoms associated with hammertoes and joint inflammation.

 

Do I Need Hammertoe Surgery?

Not everybody who has a hammertoe will need surgery. Surgery is reserved for people who have continual pain or deformity that will not respond to other treatments. This is more often the case when the hammertoe contracture becomes rigid and stiff. The goal of surgery is always to relieve pain and correct the deformity. It is important to discuss your expectations and desired activities with your foot surgeon. Make sure that you picture yourself after foot surgery and determine what it is you would like to see yourself doing once your hammertoes are straightened.  It is critical that your surgeon takes into account the types of shoes do you want to wear, the number of toes that are involved, your activity level, age and the severity of the hammertoe.  By considering all of these factors, you will have the best chance of a successful outcome. 

 

Surgical Treatment of Hammertoe Deformity

The most common procedure that is performed to surgically correct a hammertoe deformity is called an arthroplasty.  This is where a small piece of bone is removed in order straighten the toe. Another commonly performed procedure is called an arthrodesis (or joint fusion). With any fusion for correction of hammertoe deformity, the cartilage is removed from within the joint in the bones are either pinned or secured with an implant for stability. Within a few weeks, the fusion site heals and turns completely to bone removing the joint and holding the toe in alignment permanently. Arthrodesis can provide the most predictable correction. Tendon transfers, and plastic surgery procedures to lengthen the skin on the top of the toe can also be performed if necessary. Most patients have to wear a surgical shoe while recovering after hammertoe surgery.  However, most patients will be able to walk immediately after surgery.  No crutches are usually required. The overall length of recovery depends on the condition, as well as the procedure that is performed.

 

 

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