Hammer Toe Treatment

HammertoeOverview

When there?s an imbalance in the muscle and ligament surrounding a toe joint, the effect is a bend in the middle joint of the toe, which causes the whole toe to bend upward. Because the toe is bent in an unnatural way, it?s common for the toe to become irritated and even develop corns. A toe that curls under rather than bends upward is also considered a Hammer toe.

Causes

Footwear can contribute significantly to the development of hammertoes. Shoes that are too small force your toes into a curled position. Over time, your toe tendons adjust to this positioning, causing your toe or toes to hold a hammered shape. Athletes may be especially susceptible, because of the increased forces on the toes from shoes that are too small or tight. Heel elevation in footwear is also problematic, as it causes your toes to be pushed into the shoe?s toe box. Heel elevation additionally contributes to muscle imbalance. A common example of this is when your Achilles tendon-the tendon Hammer toes at the back of your leg that attaches your calf muscles to your heel bone-is too tight, causing the tendons on the top of your foot that attach to your toes to work too hard and hold your toes in an unnatural, elevated position.

HammertoeSymptoms

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

The earlier a hammertoe is diagnosed, the better the prognosis and treatment options. Your doctor will be able to diagnose your hammertoe with a simple examination of the foot and your footwear. He or she may take an x-ray to check the severity of the condition. You may also be asked about your symptoms, your normal daily activities, and your medical and family history.

Non Surgical Treatment

If you have hammer toe, avoiding tight shoes and high heels may provide relief. Initial (non-surgical) treatment for hammer toe involves wearing shoes with plenty of room in the toe area. Shoes should be at least one-half inch longer than the longest toe. Stretching and strengthening exercises for the toes (such as picking up items with the toes or stretching the toes by hand) are also recommended. Sometimes orthopedists recommend special pads, cushions, or slings to help relieve the pain of hammer toe.

Surgical Treatment

Probably the most frequent procedure performed is one called a Post or an Arthroplasty. In this case a small piece of bone is removed from the joint to straighten the toe. The toe is shortened somewhat, but there is still motion within the toe post-operatively. In other cases, an Arthrodesis is performed. This involves fusing the abnormally-contracted joint. The Taylor procedure fuses only the first joint in the toe, whereas the Lambrinudi procedure fuses both joints within the toe. Toes which have had these procedures are usually perfectly straight, but they take longer to heal and don't bend afterwards. A Hibbs procedure is a transfer of the toe's long extensor tendon to the top of the metatarsal bone. The idea of this procedure is to remove the deforming cause of the hammertoes (in this case, extensor substitution), but to preserve the tendon's function in dorsifexing the foot by reattaching it to the metatarsals. Fortunately, the Gotch (or Gotch and Kreuz) procedure--the removal of the base of the toe where it attaches to the foot, is done less frequently than in years past. The problem with this procedure is that it doesn't address the problem at the level of the deformity, and it causes the toe to become destabilized, often resulting in a toe that has contracted up and back onto the top of the foot. You can even have an Implant Arthroplasty procedure, where a small, false joint is inserted into place. There are several other procedures, as well.

Hammer ToePrevention

Although there is little doubt shoes are responsible for causing corns, the size, shape and other characteristics of our feet are hereditary. A severe bunion may cause a hammertoe, as the great toe twists over or under the second toe, causing it to dislocate.

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