Hammer Toes

Hammer toes are the most common defect of the small toes, in which the toes bend or curl up, resembling the shape of a hammer. Mostly, the second toe is affected, however, the third, fourth and even fifth toe can also be involved.

ts incidence increases with age and the condition is more commonly seen in females, probably because tight-fitting or high-heeled shoes are considered a contributory factor in the development of this deformity.

It is a slowly progressing condition. Initially, the flexed toe is extensible, but with time the joint becomes stiff, leading to a rigid, permanently bent toe.

Each small toe consists of three bones called phalanges (singular = phalanx), connected to each other at two joints, the proximal joint near the foot and the distal joint near the nail.

In hammer toes, the proximal joint is involved, resulting in downward bending of the middle toe bone.

Causes:

When wearing tight-fitting or high-heeled shoes with narrow toes, the toes are cramped and bent in the narrow toe section (high heels increase the pressure on the toes, squeezing the toes further); the muscles gradually become tight and unable to stretch. As the second toe is often longer, it is the one most commonly affected.

Bunions also increase the risk of hammer toe development, as the big toe bends outwards towards the smaller toes, pressing them and cramping their space.

Diseases which damage the nerves or muscles such as cerebral palsy, multiple sclerosis, diabetes, etc.

Inflammatory diseases which destroy the toe joints, such as rheumatoid arthritis, osteoarthritis

Flat feet are also related to hammer toe development; as the foot flattens out (pronates) the length of the foot increases, over-stretching the muscles.

It may be a result of an inherited foot shape or a previous trauma.

Symptoms:

In hammer toes, problems develop as the contracted toe rubs against the inside of the shoe and becomes painful and inflamed. Usually, the first symptom is a corn forming on the top of the toe at the bent joint, as a result of friction from the shoe. The area is painful and may also be swollen.

As the toe is bent, the area at the base of the toe (in the ball of the foot) has to support the body weight, this excessive pressure leads to pain and hardening of the skin (callus formation), in that area.

Intense friction may lead to the formation of ulcers as well.

Diagnosis:

It is easily diagnosed through visual and physical examination. The patient’s history is nevertheless important, as well as X-rays that help in evaluating the condition of the bone and any associated bone disease. Blood tests may also be required to check for other underlying diseases.

Treatment:

As the condition is progressive, for the best outcome it is best to intervene at an early stage when the toe is still flexible.

The most important measures are to:

Wear well-fitting shoes, with wider toe sections, especially if you have a bunion deformity.

The size should be half an inch larger than the longest toe.

Avoid narrow toes and high heels.

Avoid very tight stockings

Soft supportive innersoles should be worn as much as possible to control foot mechanics and to cushion high pressure areas.

If the toe is sufficiently flexible, it can be straightened out using splints or straps.

Innersoles to help with flat feet and other mechanical imbalances.

Surgical treatment:

When the toe becomes rigid, the deformity usually requires surgical correction that varies according to the condition. The proximal phalanx may be shortened to flatten the toe or the two phalanges are fused together removing the bend.