The term, hammertoe
, is commonly used as a general classification for any condition where the toe muscle weakens, causing digital
contracture, and resulting in deformity, a digital contracture like this can actually be a hammertoe, claw toe or mallet toe, depending on which joints in the toe are contracted. Clawtoes are bent at
the middle and end joints, while hammertoes are bent at the middle joint only. When it?s mallet toe, the joint at the end of the toe buckles. The skin near the toenail tip develops a painful corn
that can eventually result in an ulcer. Doctors further categorize all forms of hammertoe based on whether the affected toe is flexible, semi-rigid or rigid. The more rigid the toe, the more pain it
The main cause of hammer toe is poorly fitted and/or poorly designed footwear. Any footwear that is too tight in the toe box, especially high-heeled shoes, can push the toes forward, crowding one or
more of them into a space that is not large enough to allow the toes to lie flat and spread as they should. Other causes include the following. Changes in foot anatomy. Sometimes the metatarsal bones
in the ball of the foot can ?drop,? creating a situation in which the toes do not make contact with the surface of the shoe. The toes may then contract at one or both of the joints to re-establish
contact with the surface. Traumatic injuries in which toes are jammed or broken. Diabetic neuropathy. This can cause abnormal foot biomechanics due to nerve and/or muscle damage. Damage to nerves and
muscles from other conditions, such as arthritis or stroke. Heredity.
Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin
problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most
common at the level of the affected joint due to continuous friction of the deformity against your shoes.
A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.
Non Surgical Treatment
Many people start by treating the problem themselves when they have a painful corn or callus. They try to remove the corn by cutting it off or by applying strong acids, and they try to cushion the
toe by applying cushioned pads. Because these treatments can be difficult to perform by oneself (and should never be done by oneself when the patient is diabetic or circulation is poor), and because
these treatments only treat the symptom, not the structural deformity that causes their symptom, these treatments can often provide only limited success, and often any success is for only short
periods of time. Changes in shoe choices and various types of paddings and other appliances may help, too. For longer-lasting help, we must examine the cause of the deformity. The reason for knowing
the cause is that the type of treatment will vary, depending upon the cause of the complaint. Orthotics help control the causes of certain types of contracted toes, (those caused by flexor
stabilization, for example), but not other types.
The deformity is corrected in a variety of ways. There are actually a large number of procedures. The simplest procedure would involve a Tenotomy, the cutting of the tendon causing the deformity or a
Tendon Lengthening procedure. These procedures are infrequently done, though, as the structural deformity (the arthritis and joint adaptation) is not addressed with these surgeries. Other soft-tissue
procedures involve rebalancing the tendons around the joint. There are several techniques to do this, but the most common is probably the Girdlestone-Taylor procedure, which involves rerouting the
tendons on the bottom of the toe up and over the toe where it sticks up, so that the tendon helps pull the toe downwards into proper alignment.
Prevention of a hammer toe can be difficult as symptoms do hammertoes
not usually start until the problem is well established.
Wearing shoes that have extra room in the toes may help the problem or slow down its development.