- Also called:
- hammer toe
- Related Topics:
- toe
hammertoe
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What is a hammertoe?
A hammertoe is a deformity of the second, third, or fourth toe, where the toe bends downward at the middle joint, resembling a hammer. Most often, it affects the second toe.
Initially, the affected toe is flexible, but over time, the tendons may tighten and stiffen permanently, causing pain, corns, and calluses.
Hammertoe is often caused by wearing poorly fitting shoes, especially those that narrow toward the toes or have high heels. Other factors include anatomical problems, bunions, toe trauma, and medical conditions like arthritis or diabetes.
Nonoperative treatments include padding, strapping, and shoe adjustments. Surgery may be needed for inflexible cases.
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Which toes are usually affected by hammertoe?
Hammertoe is a deformity where a toe bends downward at the middle joint, resembling a hammer. It typically affects the second, third, or fourth toe, with the second toe being the most common. Often, only one or two toes are affected. However, in rare instances, all toes may be involved, necessitating a thorough neurological evaluation to check for underlying nerve or spinal cord issues.
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What causes a hammertoe to develop?
A common cause of hammertoe is wearing improperly fitting shoes over time. High heels or shoes that are too small or narrow can push and crowd the smaller toes into a bent position. This can weaken toe muscles, diminishing their ability to straighten the toe. Feet rubbing against the toe box of shoes may also aggravate the condition and lead to corns and calluses. Other factors that can increase the risk of hammertoe include bunions, anatomical problems, MTP joint instability, and previous toe trauma. Medical conditions such as diabetes, neuromuscular disease, and inflammatory joint diseases can also increase the risk.
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How does a hammertoe affect the way you walk?
A hammertoe is a deformity of the second, third, or fourth toe, where the toe bends downward at the middle joint, resembling a hammer. This condition can affect your walk by causing pain in the toe, especially on the top of the middle joint, due to the development of hard corns from pressure and friction. A painful callus may also form on the ball of the foot from chronic stress. Hammertoe may lead to altered foot mechanics and gait changes as you compensate for the discomfort. Inflexible hammertoes can need surgery to allow for repositioning.
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What symptoms might someone with hammertoe notice?
Hammertoe is a deformity of the second, third, or fourth toe, where the toe bends downward at the middle joint, resembling a hammer. This condition is often linked to hyperextension of the metatarsophalangeal (MTP) joint and a second toe that is longer than the big toe.
Symptoms may include pain on the top of the middle toe joint due to a hard corn, which develops from chronic pressure and friction. A painful callus can also form at the end, below the toenail, or on top of the toe. The ball of the foot may be painful, with a callus on the sole from stress caused by partial or complete dislocation of the proximal phalanx. In those with decreased sensation in their feet, like people with diabetes, there is a risk of lesions and infection at the pressure points.
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What treatments are available for hammertoe, and how do they help?
Hammertoe is a deformity of the second, third, or fourth toe, where the toe bends downward at the middle joint. Treatments range from nonoperative to surgical, depending on severity.
Nonoperative treatments include padding, strapping, and taping to reduce deformity and relieve pressure. Exercises can correct muscle imbalance and joint instability. Properly sized, low-heeled footwear helps reduce pain and progressive deformity.
Surgery becomes necessary when conservative treatments fail or the hammertoe is inflexible. Flexible deformities may be treated with tendon lengthening or tendon transfer. Rigid deformities are treated with arthroplasty to remodel the joint and relieve pressure.
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hammertoe, deformity of the second, third, or fourth toe in which the toe is bent downward at the middle joint (the proximal interphalangeal [PIP] joint), such that the overall shape of the toe resembles a hammer. Most cases of hammertoe involve the second toe, and often only one or two toes are affected. In rare cases when all the toes are involved, a thorough neurological assessment is necessary to evaluate for underlying nerve or spinal cord problems.
Hammertoe occurs more frequently in women than in men. Children who continue to wear shoes that they have outgrown are also at risk. Poorly fitting shoes can cause deformities in the PIP joint as well as in the metatarsophalangeal (MTP) joint (where the base of the toe attaches to the rest of the foot).
Characteristics of hammertoe
Hammertoe tends to be associated with hyperextension of the MTP joint as well as with having a second toe that is longer than the big toe. Initially, the affected toe maintains flexibility. Flexible deformities can be manipulated through therapy such that the affected joint is moved back into a neutral position. However, over time the tendons may tighten and can become permanently stiff. Fixed deformities do not allow repositioning and generally require surgery to be corrected.
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Hammertoe tends to produce pain in specific areas of the foot. The skin on the dorsal surface of the PIP joint (the top of the middle toe joint) can become painful owing to the development of a hard corn. The corn results from chronic pressure that forces the toe to buckle and from chronic friction that irritates the skin. A painful callus can also develop at the end of the toe, just below the tip of the toenail or on the top of the toe. The ball of the foot may also be painful, and a painful callus may form on the sole of the foot from chronic stress caused by the partial or complete dislocation from the joint of the proximal phalanx (the toe bone that connects to the rest of the foot). In patients with decreased sensation in the feet, such as persons with diabetes mellitus or persons born with myelomeningocele (a type of spina bifida), there is a risk of ulceration (development of lesions) and infection at the pressure points involved in hammertoe.
Causes of hammertoe
The most-common cause of hammertoe is the long-term use of poorly fitting shoes. Shoes that narrow toward the toes, that have high heels, or that are too small are the common culprits. Shoes that narrow toward the toes cause crowding of the smaller toes and push them into a flexed (bent) position. The condition can be aggravated by the feet rubbing against a small toe box (the part of the shoe that accommodates the toes), which can also lead to the formation of corns and calluses. High-heeled shoes increase the pressure placed on the ball of the foot and the toes. They force the toes down against the narrow toe box and increase the bend in the toe. With long-term use, the toe muscles weaken and lose the ability to straighten the toe.
A combination of other factors can also increase the risk of hammertoe, including anatomical problems, bunions (hallux valgus), MTP joint instability, and previous toe trauma. A long second toe, for example, may be forced into a bent position by an improperly fitted shoe. Bunions form when the big toe is forced in the direction of the second toe. The resultant pressure placed on the second toe can cause abnormal positioning and bending of the second toe, particularly when compressed into shoes. Prior trauma to a toe, such as a sprain, strain, fracture, or dislocation, increases the risk of abnormal toe anatomy and positioning problems.
Medical conditions can also increase the risk of hammertoe. Studies have associated hammertoe with connective tissue disorders, neuromuscular disease, degenerative disk disease, inflammatory joint diseases, and diabetes. Rheumatoid arthritis causes hammertoe deformity by progressive destruction of the MTP joint, leading to joint instability. Diabetics with peripheral neuropathy are prone to hammertoe, because chronic nerve and muscle damage to the foot results in abnormal foot mechanics.
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Treatment of hammertoe
A variety of nonoperative treatment options exist for hammertoe. Padding, strapping, and taping are helpful for reducing the degree of deformity and for relieving pressure over painful joints. Foam or other padding is placed over the hammertoe or at the tip of the toe to prevent friction with shoes. Tube gauze (a sleeve of gauze that slips over the toe) and toe caps (material used to cover the toe) also may be used. Soft shoe insoles and arch pads may be used to help redistribute weight away from painful areas. Tape and toe slings may be used to position the MTP joint in a slight plantar flexion (as in pointing the toes), enabling the PIP joint to straighten. Stretching and strengthening of the toe muscles, such as through exercises in which the toes are used to lift small objects off the floor, can help correct muscle imbalance and joint instability.
Properly sized and low-heeled footwear help reduce pain and progressive deformity. Shoes also can be adjusted to accommodate the hammertoe. For example, the toe box can be stretched so that it bulges around the toe, reducing the risk of contact at the top of the shoe.
In instances when conservative treatments fail, pain is disabling, or the hammertoe is inflexible, surgery may be needed. There are a range of surgical options, and the choice is based on the type and severity of the deformity. Flexible deformities may be treated with flexor tenotomy (also known as tendon lengthening or tendon release) or flexor-to-extensor tendon transfer. Tendon transfer involves repositioning of the tendon to straighten the toe.
Rigid deformities are treated with arthroplasty of the PIP joint. Arthroplasty involves the removal of some bone and cartilage to remodel the joint and correct the deformity. The goal is to shorten the toe in order to relieve pressure, alleviate pain, and ultimately straighten the toe. In more-severe cases, additional procedures may be necessary, including reconstruction of the surrounding tendons and ligaments, arthrodesis (joint fusion), derotation arthroplasty (in which skin and bone are removed in order to straighten the toe), and metatarsal shortening osteotomy (in which a cut is made through the affected metatarsal bone to shorten the toe). In cases of concurrent MTP joint instability or abnormality, hammertoe surgery may also include correction of the MTP joint to prevent a recurrence of the hammertoe deformity.