Hammertoe Demystified: Unveiling the Truth behind Symptoms, Causes and Treatments

What is a hammertoe?

A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint (the middle joint of the toe) of the second, third, fourth, or fifth toe causing it to be bent upward, while the end joint is bent downward. This causes the toe to look like a hammer, hence the name.

hammertoe infographic

There are three types of hammertoes:

Flexible hammertoes

A flexible hammertoe is still developing, so the affected toes are still able to move at the joint.

Semi-rigid

The hammertoe is starting to stiffen.

Rigid hammertoes

A rigid hammertoe can no longer move because the tendons and soft tissues have tightened.

What is the main cause of hammertoes?

Hammer toe can cause pain, corns, and calluses, and is often caused by wearing shoes that don't fit properly or by an imbalance in the muscles of the foot. Hammer toe can cause walking to be painful; and can make it difficult to wear shoes.

Abnormal muscle balance in your toe can lead to increased pressure on the tendon and joints, which can lead to a hammertoe. Causes of that muscle imbalance include:

  • Genes: The foot type you’re born with may predispose you to develop this type of joint deformity. Flat feet can lead to hammertoes as the foot tries to stabilize against a flattening arch. Feet with high arches can also form hammertoes as the extensor tendons overpower the flexors.
  • Poor fitting shoes: Shoes that are too tight or too narrow, ill-fitting shoes, high heels, or shoes with pointed toes, and shoes having little to no arch support. High heels put severe pressure on the toes and their joints. That’s why more cases of hammertoes are found in women than men.
  • Neuromuscular disease: Neuromuscular diseases can contribute to the development of a hammertoe. People with arthritis or diabetes can be at increased risk for complications. For diabetics, a toe with a corn or other ulceration indicates there's too much pressure on the toes. Infected corns and lesions can be serious in those individuals.
  • Trauma: Rarely, trauma to your toe can result in a hammertoe.

Is hammer toe caused by diabetes?

Hammertoe is not directly caused by diabetes, but diabetes can contribute to the development and progression of hammertoe. Toe deformities such as hammer toe can also be caused by muscle, nerve, or joint damage, resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia (GAA trinucleotide repeat).
   

What are the symptoms of hammertoe?

Symptoms of hammertoe include discovering a joint in your toe that’s getting rigid; pain at the top of the bent toe; pain in the ball of the foot and corns and calluses at the top of the joint; redness, inflammation, or a burning sensation; restricted, painful motion of the toe joint; swelling at the joint; open sores.
    

At what age do hammer toes develop?

You can develop hammertoes at any age although they are more commonly seen in adults.

Is hammer toe progressive?

Mens hammer toes with dislocated joints before surgery
Hammer toe can indeed be progressive if left untreated or unmanaged. At its early stages, hammer toe may be flexible and easily corrected. However, without appropriate intervention, it can gradually worsen over time. The affected toe may become rigid, making it difficult to straighten or bend. The toe joint can also develop structural changes, such as contractures or misalignments. Additionally, the accompanying symptoms, such as pain, discomfort, and difficulty in wearing certain footwear, can intensify as the condition progresses. It is crucial to seek timely medical attention and explore suitable treatment options to prevent or slow down the progression of hammer toe and maintain foot health.
     

Are there any non-surgical treatments for hammertoe? 

In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to improve and even resolve the condition. The patient's doctor may prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor.

Some additional remedies may include:

  • Using custom shoe inserts/orthotic devices that can control how your foot functions
  • Taking anti-inflammatory drugs or getting cortisone shots to alleviate your pain
  • Taping your toes to change the muscle imbalance
  • Using Insulating padding around the hammertoe to minimize pressure

Doctor holding orthopedic insoles

What can a podiatrist do for hammer toes?

If you suspect that you may have hammer toe, it's important to see a podiatrist or foot specialist for an accurate diagnosis and for treatment recommendations. A specialist can help you to determine the best course of action based on the severity of your condition and your overall health. You can start with your primary care physician (PCP) or visit a podiatrist (foot and ankle doctor) for a thorough physical exam. Your provider will look at your footwear, check the toe’s flexibility, do a gait analysis to assess the way you walk, take an X-ray of your foot to rule out fractures and see the extent of any damage, perform a foot and ankle exam, and debride (remove) any painful skin or nail.

How do I know if I need hammertoe surgery?

If your pain is severe, if your hammertoe interrupts your daily activities, and if non-surgical treatments haven’t helped and the toe joint is rigid and no longer moveable, your doctor may recommend surgery. The actual procedure will depend on the type and extent of the deformity.

  • Tendon lengthening. For patients with a flexible toe joint, the condition can often be treated by lengthening the tendons that are causing the joint imbalance.
  • Tendon transfer. Some patients with a flexible toe joint may benefit from treatment that involves transferring tendons from the bottom of the toe to the top of the toe to help pull the joint into a straight position. 
  • Arthrodesis (joint fusion). Patients who have a rigid toe joint may undergo tendon lengthening in combination with arthrodesis. In this procedure, your doctor will remove a small part of a bone in the toe joint to ensure that the toe can extend fully. He or she will then insert an external wire or pin and/or internal plate to hold the bones in place while the bones fuse together.

Post Hammertoe Surgery Foot with pins in toes

Are you awake during hammer toe surgery?

Yes. Surgery is typically performed on an outpatient basis using a local anesthetic. 

Is hammer toe surgery painful?

You should not feel any pain during a hammertoe surgery. You may feel some pulling or pressure. Depending on the severity and the procedure as well as your own personal health (everyone is different) recovery time will vary. Some people are up and walking within a week while others have taken weeks to recover.

Do you need crutches after hammer toe surgery?

The need for crutches is determined on a case-by-case basis. In some cases, hammertoe surgery may involve the realignment or removal of bone, tendons, or other tissues in the toe. The recovery period and the use of crutches can vary depending on factors such as the number of toes operated on, the type of surgery performed, and a persons overall health. Your doctor will give you a better idea of what to expect based on the specifics of your particular case.

What shoes should I wear if I have hammertoes?

When it comes to selecting the ideal footwear if you have hammertoes or for the prevention of hammertoes altogether, certain considerations come into play. If your job requires you to wear dress shoes it's imperative to find dress shoes that cater to these specific needs while providing a touch of style and sophistication.

First and foremost, pay attention to the roominess of the toe box. Opt for dress shoes that offer an abundance of space, allowing your toes the freedom to move unhindered and avoid any unpleasant crowding. Steer clear of those narrow or pointy-toed shoes that unkindly squeeze your toes together, aggravating hammertoes and bringing about discomfort.

Mindful of the height, select dress shoes that boast a heel of low or moderate stature. Shoes with a higher heel exert undue pressure upon your toes, exacerbating existing hammertoes or presenting the unwelcome prospect of new ones.

Take a moment to consider the importance of materials as well. It's worth seeking out dress shoes that are crafted from supple and flexible substances, designed to gracefully accommodate the unique contours of your feet. The touch of leather or suede uppers, with just a hint of stretch, can work wonders in reducing friction and enhancing overall comfort.

Now, let's explore the inner workings of dress shoes. Pay close attention to the importance of cushioned insoles, as they play a vital role in providing an additional layer of comfort and support. By reducing the impact on your feet, they offer a soothing haven and much-needed relief to your deserving toes. For an even more tailored experience, consider enhancing your shoes with orthotic inserts or perhaps custom-made orthotics. This extra touch will infuse them with additional cushioning and optimal arch support, resulting in a heavenly match that your feet will surely appreciate.

When it comes to realm of closures, choose the option that allows you to customize the fit. Laces, buckles, or even Velcro straps give you the ability to fine-tune the snugness, enabling your shoes to adapt to any potential swelling or changes in your foot's particulars.

Did you know that we now offer velcro options which allow you to adjust the snugness and at the same time will make it easy for you to remove your shoe quickly which can be important if you are struggling with foot issues such as hammertoe or clawtoe. You can see our velcro options here.

But remember, the key to finding the perfect dress shoes if you have hammertoes lies in obtaining the right size and fit. Stay far away from shoes that are too constricting or overly loose as they are certain to exacerbate your foot-related issues.

Check your feet regularly for signs of irritation, blisters, or redness to catch foot problems early and prevent them from worsening. And always consult a podiatrist or foot specialist for proper guidance and treatment options for your foot health. For more information on other foot related issues check out our foot pain charts here.

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