Hammer toe is a secondary problem originating from fallen cross arches. The toes start to curl and get pulled backwards, as the collapsed or pushed out metatarsal bones pull the tendons and ligaments, and causes them to get shorter and tighter. This condition causes the toes have higher pressure and they have limited movement and cannot be straightened fully. This can lead to numbness and pain in the toes as muscles, nerves, joints and little ligaments are involved with this condition. As the top part of the toe can rub against the shoe, it can cause corns and calluses.
Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.
Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.
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
Treatment options for a hammertoe are based on the severity of the condition. A hammertoe caused by inappropriate footwear can be corrected by wearing properly fitting shoes. If a high arch caused the condition, wearing toe pads or insoles in your shoes can help. These pads work by shifting your toe?s position, which relieves pain and corrects the appearance of your toe.
If you have a severe case of hammer toe or if the affected toe is no longer flexible, you may need surgery to straighten your toe joint. Surgery requires only a local anesthetic (numbing medicine for the affected area) and is usually an outpatient procedure. This means you don?t have to stay in the hospital hammertoe for the surgery.
Although the feet naturally change over time, and abnormalities like hammertoes may be hereditary for some patients, steps may be taken to prevent their development in the first place. Just as better fitting shoes are a treatment, they are also a preventative measure for hammertoes. In addition, your podiatrist may suggest orthotics to improve the biomechanics of your feet in an effort to prevent the development of hammertoes or other abnormalities. Calf stretching and other exercises may also be used to reverse or treat muscle imbalances that could eventually lead to hammertoe development.