Hammer Toe Causes And Therapy

Overview

Hammer toes can affect any of the toes on the foot except the big toe, though the most common toe to suffer is the second one. While the smallest toe can be affected, the condition causes the toe to twist out to the side rather than to curl forward. Hammertoe is not very discriminating; it may appear on all four toes of the foot or on only one toe, depending on the cause.

Causes

Those fashionable shoes. Women tend to cram their feet into too-narrow, ill-fitting shoes with little to no arch support. That?s why we see more hammertoes in women than men. Pointy, high-heeled shoes put severe pressure on the toes and their joints, and they typically have little to no arch support. Neuromuscular diseases can contribute to the development of hammertoe, too. People with diabetes can be at increased risk for complications from a hammertoe. In diabetics, if a toe has a hammertoe corn or other ulceration, it indicates there is too much pressure on the toes. In those with poor blood flow or neuropathy, these lesions can get infected and lead to the loss of a toe or foot unless shoes are modified.

Symptoms

If the toes remain in the hammertoe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when shoes are not being worn. The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward, thickening of the skin above or below the affected toe with the formation of corns or calluses, difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.

Diagnosis

First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.

Non Surgical Treatment

If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the purpose of each is the same: to stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.

Surgical Treatment

Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.