When your toes curl downward or bend uncontrollably, you may have a correctable condition called hammer toe. You can fix this problem with or without surgery.
This is usually a deformity of the middle joint of the second, third or fourth toe (it can also affect the fifth toe). Normally, hammer toes are flexible and can be corrected fairly easily when treated early, but the problem may require surgery if it has lingered. The condition, however, is not dangerous and doesn’t need treatment if you don’t experience symptoms of pain or rubbing.
The cause of hammer toe is usually shoes that don’t fit properly or a muscle imbalance. Muscles work in pairs to straighten and bend your toes. If a toe is bent and held in one position long enough, it can't 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.” according to the American Orthopaedic Foot and Ankle Society. “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.”
Preventive treatment involves a functional orthotic, or a special insert your podiatrist can prescribe.
These inserts can be seen as “contact lenses” for the feet. They correct a number of foot problems that are caused by an abnormally functioning foot. “Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot,” writes Kirk A. Koepesel, DPM.
Treatment of symptomatic hammer toe consists of open toed shoes or hammer toe pads. You can also use over-the-counter corn removers for temporarily removing the painful calluses that sometimes accompany hammer toe. But, since they contain a mild acid, you should use them with caution.
Curative treatment of hammertoe can involve simple surgery, such as the release of a tendon; you will lose the ability to bend the toe, however, because the tendon is cut or your joint is fused. “The recovery is rapid, often requiring nothing more that a single stitch and a Band-Aid,” Koepesel writes.
The surgical correction of a rigid hammer toe is more complicated. It involves removing the skin where the corn is located and a small section of bone at the level of the rigid joint. Recovery takes longer, with sutures remaining in place for about 10 days. It’s important to stay off your foot as much as possible during this time.
You may be able to relieve your symptoms with home treatment. Your options include applying a commercial, non-medicated hammer toe pad to decrease pressure, wearing a shoe with a deep to box, applying ice packs several times a day to reduce swelling, and avoiding heels more than two inches tall.
While home treatments will make your hammer toe feel better, you should remember they won’t cure the condition. You’ll need to see a podiatrist to repair the problem.
“Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot,” says podiatrist Evelyn Cavalier, MD, of New York City. “During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes.”
Sometimes, hammer toe is caused by some kind of trauma, such as a previously broken toe. In some people, hammertoes are inherited.
In any case, there you have many options to treat painful hammertoes, from simple home remedies to quick outpatient surgery.
March 25, 2020
Christopher Nystuen, MD, MBA