Hammer Toes - Causes, Types, Symptoms, Diagnosis, and Treatment

Introduction

Hammer toes are toes that are bent permanently. They are also referred to as claw toes, mallet toes, or retracted toes. Hallux valgus, or experiencing the toes squeezed by ill-fitting shoes or socks, are the two conditions that lead to hammer toes. Most of the patients with hammer toes have bunions or abnormally arched feet. Hammer toe discomfort is typically brought on by a buildup of calluses and corns over the elevated joints. Although it is rare, there is also a chance of developing an ulcer.

What Is the Anatomy of the Toe?

Five toes make up the forefoot. Every toe has three joints except for the first (big) toe, which typically has just two. The middle joint, referred to as the proximal interphalangeal (PIP) joint, is bent in the case of the hammer toe.

What Are the Causes of Hammer Toe?

A muscle imbalance that strains the toe tendons and joints leads to a hammer toe. Toes are bent and straightened by pairs of muscles. Long-term toe bending causes the muscles and joints to constrict and become immobile.

This imbalance is frequently brought on by wearing improperly fitting shoes. The smaller toes are forced into a flexed (bent) position by shoes that get narrower nearer the toe. The issue is made worse by the toes rubbing against the shoe, which causes corns and calluses to grow. Higher-heeled shoes squeeze the foot down and the toes up against the shoe, creating pressure and toe bend. The toe muscles eventually lose their ability to straighten the toe.

Who Are All Susceptible to Developing Hammer Toes?

A hammer toe is more likely to develop if certain risk factors exist. These consist of the following:

• A hammer toe history in the family.

• Wearing pointed or tight shoes all the time.

• Possessing skin layers that are thickened as a result of repetitive, persistent friction, such as calluses, bunions, or corns.

If one is wearing too-small shoes, the toes joint may be pressed into an uncomfortable position. The muscles are unable to expand out as a result. Wearing shoes that do not fit properly often raises the risk of developing:

• Bunions.

• Corns.

• Hammertoes.

• Blisters.

• Ulcerations.

What Are the Types of Hammertoe?

Hammertoes come in three varieties:

• Flexible Hammertoes: Since a flexible hammertoe is still growing, the toes that are afflicted can still move at the affected joint.

• Semi-rigid Hammertoe: The hammertoe is beginning to tighten and become semi-rigid.

• Rigid Hammertoes: As the tendons and soft tissues have tightened, a stiff hammertoe is immobile.

What Are the Symptoms of Hammer Toe?

Walking is uncomfortable if one has a hammer toe. Additionally, it can hurt to try to stretch or move the affected toe or the ones nearby. There are various degrees of hammer toe symptoms.

Symptoms that are not severe include the following:

• A bent toe.

• Calluses or corn.

• Walking difficulties.

• Not being able to move the toes or flex the foot.

• Claw-shaped toes.

How Is Hammer Toe Diagnosed?

• Physical Examination: A physical examination by the doctor will reveal if the toe joint is flexible or rigid. The patient can choose the best course of action with the use of this information.

• X-Rays: Images of dense things, like bone, are produced by X-rays. To confirm the diagnosis, the doctor can ask for an X-ray of the foot in question.

• Various Tests: To ascertain whether a neurological disease is the root of the tendon imbalance, patients with diabetes or reduced sensation in their feet may need additional tests.

How Is Hammer Toe Treated?

Treatment for hammer toe in its early stages usually comprises straightforward procedures while the joint is still malleable.

1. Non-surgical Treatment:

• Alterations to Footwear: The doctor will advise against wearing high-heeled, thin, tight-fitting footwear. Shoes should have a soft, wide toe box and be half an inch longer than the longest toe, which is frequently the second toe for most people. Additionally, one might be able to locate footwear with a roomy toe box that can fit a hammer toe. A toe box could be stretched out in a shoe repair shop such that it protrudes outward around the toe. If the sandals do not irritate or pinch other parts of the foot, they might be helpful.

• Exercises: The muscles in the foot can be stretched and strengthened with the use of specific workouts. The doctor could advise gently stretching the toes manually or picking objects up off the ground with the toes. To strengthen the toes, the doctor might also suggest performing "towel curls." Place a towel flat under the foot and crumple it with the toes to conduct a towel curl.

• Prescription-Free Treatments: Pain can be reduced by using straps, cushions, or non-medicated corn pads that are sold commercially. Before attempting any self-treatment, consult a physician if one has diabetes, poor circulation, or numbness in the feet.

2. Surgery: The doctor may advise surgery if the toe joint is stiff and immobile or if nonsurgical treatment does not help alleviate the symptoms. A local anesthetic is often used to perform surgery on an outpatient basis. The specific steps will vary depending on the kind and severity of the deformity.

• Lengthening of the Tendon: The issue is frequently treatable in people with flexible toe joints by extending the tendons responsible for the imbalance in the joint.

• Tendon Transfer: To assist in drawing the flexible toe joint into a straight position, some individuals with flexible toe joints may benefit from treatment that involves moving tendons from the bottom to the top of the toe.

• Joint Fusion, or Arthrodesis: Patients with stiff toe joints might also have tendon lengthening done in addition to arthrodesis. The physician will perform this procedure to ensure that the toe can extend by removing a small portion of a bone from the toe joint. After that, the doctor will put an internal plate, an exterior wire, or both to hold the bones in position as they fuse.

How Is the Recovery of the Hammer Toe?

Patients can have some stiffness, edema, and redness in their toes for up to four to six weeks following surgery. While the toe heals, it can put pressure on the foot right away, but one should try to limit activities while it does. Elevating the foot as much as possible will lessen pain and hasten healing. The toe might be a little bit longer or shorter after healing.

Conclusion:

A type of foot deformity known as a hammer toe is characterized by the toe bending or curling downward instead of forward due to an imbalance in the muscles, tendons, or ligaments that hold the toe straight normally. Although it can affect any toe, it typically affects the second or third toe and causes an abnormal bend in the toe's middle joint. It could be a birth deformity or develop gradually as a result of arthritis, wearing uncomfortable footwear like tight, pointed heels, foot anatomy, or particular injuries. Although it is very painful, it is treatable.