Hammertoes

Hammertoes are a contracture (bending) of one or both joints of the second, third, fourth, and/or fifth toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with conservative measures. If left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Causes

The most common cause of a hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.

Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, a hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Symptoms of Hammertoes

• Pain or irritation of the affected toe when wearing shoes
• Corns and calluses (a buildup of thickened skin) on the toe, between two toes, or on the ball of the foot, which may be soft or hard depending upon their location
• Inflammation, redness, or a burning sensation
• Contracture of the toe
• In more severe cases of hammertoes, open sores may form

Non-Surgical Treatment

There are a variety of treatment options for hammertoes. Treatment options depend upon the severity of your hammertoe and other factors. A number of non-surgical measures can be undertaken:

• Padding corns and calluses: pads designed to shield corns and calluses from irritation
• Changes in shoe gear: avoid shoes with pointed toes, shoes that are too short, or shoes with high heels, and instead choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches
• Orthotic devices: a custom orthotic device placed in your shoe may help control the muscle/tendon imbalance
• Injection therapy: corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoes
• Medications: oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may be recommended to reduce pain and inflammation
• Splinting/strapping: splints or small straps may be applied by the surgeon to realign the bent toe

Surgical Treatment

• Tenotomy and capsulotomy: releasing the tendon and joint capsule that is keeping the toe in a bent position
• Arthroplasty: removal of a small section of bone from the affected joint
• Arthrodesis: fusion of the affected joint with or without a permanent implant
• Implants: there area a variety of hammertoe implants, including K-wires, metal implants, silicone implants, and allograft implants, all with the goal of helping to keep the toe in a corrected position
  • K-wires: sterile metal wires that are temporarily used to keep bones aligned and fixated until healing occurs, then the wires are removed
  • Metal implants: small implants used to help fuse a joint in the toe and to help keep the toe permanently corrected, these implants are usually left in permanently
  • Silicone implants: soft flexible implants that often can help retain length of the toe and some motion at the joint after the hammertoe is corrected, these implants are usually left in permanently but can be removed if needed or if desired
  • Allograft implants: made from sterilized and processed donor bone that is used to help fuse a joint in the toe and are resorbed (replaced by the body’s natural bone) over time