Overview
Hammer toes are usually not a serious condition, but can become painful as the bent joint rubs against the inside of the shoe, causing irritation, corns, or calluses on the top of the middle joint or Hammer toes the tip of the toe. A Hammer toe may also cause occasional shooting pains throughout the toes or elsewhere in the foot. A hammertoe has a kink or contracture in its second joint--called the proximal interphalangeal joint--that causes the toe to bend upward in the middle, giving it a hammer-like appearance. The raised part of the toe often rubs on shoes, leading to the formation of corns or calluses. Usually hammertoe affects the smaller toes, causing pain and interfering with the ability to walk normally.
Causes
As described above, the main reason people develop hammertoes is improper footwear, or footwear that is too short for the toes. Shoes that do not allow our toes to lie flat are the biggest cause of hammertoes, though there are others, including genetics, injury or trauma in which the toe is jammed or broken. Diseases that affect the nerves and muscles, such as arthritis. Abnormal foot mechanics due to nerve or muscle damage, causing an imbalance of the flexor and extensor tendons of the toe. Systematic diseases such as arthritis can also lead to problems such as hammertoe. Some people are born with hammertoes, while others are more prone to developing the condition due to genetics. If you have ever broken a toe, you know there is not much that can be done for it. It is one of the only bones in the body that heals without the use of a cast. A broken toe may be splinted, however, which may help prevent a hammertoe from forming.
Symptoms
A soft corn, or heloma molle, may exist in the web space between toes. This is more commonly caused by an exostosis, which is basically an extra growth of bone possibly due to your foot structure. As this outgrowth of excessive bone rubs against other toes, there is friction between the toes and a corn forms for your protection.
Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. (Note: For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe specialist (Pedorthist) may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.
Surgical Treatment
Until recently, wires were used for surgical correction. In this technique, one or more wires are inserted into the bone through both the affected joint and a normally healthy toe joint, and the end of the toe. These wires stay in place for four to six weeks, protruding from the end of the toes. Due to the protruding wire, simple things such working, driving, bathing and even sleeping are difficult while these wires are in place. During this recovery period, patients often experience discomfort during sleep and are subject possible infection.