Hammer toes are far more common than most of us think and can make something as simple as walking an everyday ordeal. A hammer toe is an abnormal flexion in one or more of the smaller toes caused by muscle imbalance, bad footwear choices or systemic illness. Without early recognition and treatment a mild nuisance can become something quite painful that will restrict the individual from movement.
This article aims to give the reader an insight into what hammer toes are, why they occur, signs to look for and the various options of treatment from conservative to surgical.
What Are Hammer Toes?
A hammer toe is a type of deformity which causes the middle joint of a toe to droop downward, giving it the appearance of a hammer. They are most common in the 2nd, 3rd, or 4th toes. Hammer toes can occur gradually over a period of years, beginning as just some stiffness of the toe and ending up with a rigid deformity.
Knowing what type of problem you’re faced with is important — as hammer toes are not all created equal, and what works for one problem toe may not work for the next.
Hammer Toe vs. Other Toe Deformities
There is often confusion over the terms hammer toes, claw toes and mallet toes but they all involve a different joint. The hammer toe involves a bend in the proximal interphalangeal joint of the toe (middle knuckle). The mallet toe is bent at the distal joint near the end of the toe.
A claw toe is a more serious deformity as it causes a bend in more than one joint at the same time and usually causes the whole toe to curl downwards. Correctly identifying the location of the bend allows a doctor to recommend the most suitable treatment.
Flexible vs. Rigid Hammer Toes
The initial stage of hammer toe is flexible, meaning the joints can be manipulated back into a straightened position with common pressure. This is a positive thing because initial flexible hammer toes are very treatable with conservative measures. When the joints become fixed or rigid, and are unable to be manipulated back to neutral, the more aggressive methods are utilized.
Hammer Toes Causes and Risk Factors
Hammer toes are not something that happen suddenly, the formation of hammer toes takes many months or even years to occur and is caused by a variety of mechanical, genetic or lifestyle factors. The predisposition of each individual can be very different, some have a structure of the foot which makes them more prone to the formation of hammer toes while others may only have them due to external factors such as inappropriate footwear.
Footwear, Foot Shape, and Muscle Imbalance
Shoes that are too tight, especially high heels, are one of the most common culprits for the cause of hammer toe. Shoes that bear the toes in a bent or pig-toed position may cause the muscles and tendons to become shortened and adapt to that position. High arches may alter the distribution of weight through the foot in a manner that affects the smaller toes.
Muscle imbalance—where the tendons on one side of the toe are always tighter than on the other—causes the joint to be pulled into that bent shape and stay that way.
Underlying Conditions and Age-Related Changes
Some pathologies are more strongly associated with the development of hammer toes. Rheumatoid and osteoarthritis, for example, are both distorters of the joint architecture and can hasten deformity. Diabetic neuropathy may lead to loss of sensation in the feet, so that minor mechanical insults go un-noticed until the deformity is well established.
Past toe injuries, whether fractures, dislocations or ligament injuries, may lead to aberrant reconstruction during the healing process. Aging alone has an impact, as the extensor tendons shorten, with fat pad loss occurring in the forefoot and this may increase the propensity for structural change.
Hammer Toes Signs and Symptoms Recognition
Early detection of hammer toes can give you the best opportunity for non surgical treatment. The deformity itself—the bend—of the toe is usually the first thing you notice, but there are some less obvious signs which can present themselves before the condition becomes quite so noticeable. Pain, redness and difficulty obtaining footwear are all warning signs you should notice.
Early Warning Signs and Self-Checks
Early signs include a stiff toe after a time when it was once freely mobile. There may be a tendency of one toe to scratch or become roughened by the top of the shoe or a sensation of burning or slight aching after standing for long periods. Try to get the toe on the floor before the door when you are sitting: if this fails to do so or gives you pain these should be reported early to your doctor.
Complications: Corns, Calluses, and Mobility Problems
Complications increase significantly if the hammer toes are not treated. Corns are formed over prominent metatarsal heads as a result of pressure and friction from the toe against the shoe. Calluses may be formed due to increased weight bearing on the forefoot because of the deformity.
The deformity in severe cases may lead to poor balance and gait and thus significantly impair walking and functional mobility, and thereby falls may occur. Patients with diabetes may be prone to open sores which cause infection.
Everyday Prevention and Long-Term Foot Care
Prevention is easy once you recognize the signs. So many cases of hammer toe could be prevented—or at least greatly postponed—simply by wearing the proper shoes and giving our feet some regular TLC. They’re not big changes, but they do take regular application.
Choosing Foot-Friendly Shoes and Socks
Wear shoes with a broad, deep toe box. Your toes should be able to lie flat, without squeezing against each other or the shoe. We found a modest decrease of forefoot pressures with shoes with heels over two inches.
Beyond two inches it is worth avoiding taller shoes as the impact on pressure is substantial. Use seamless socks to decrease friction, wear breathable materials for increased health in the skin. If shoe shopping do so later in the day as feet tend to be more swollen.
Simple Toe Exercises and Self-Care Habits
Toe stretches and strengthening exercises can really help slow the forward progression of early deformity. Picking up little objects such as marbles with the toes, towel scrunches, and gentle manual stretching of each toe can help maintain joint range of motion and tendon length. Warming the feet in warm water before stretching and exercises can make all the difference.
Regular inspections of the feet for any new pressure points, changes to the skin or deformity progression mean you will detect early changes – which again for hammer toes really does make all the difference.