Keeping Feet Naturally Healthy: A Podiatry Blog

Hammer toe is one of the most common foot conditions around, and also up there with the most painful if left untreated for too long. However, many people who are treated for hammer toes are ignorant of what causes them, causing painful relapses that can be expensive to treat, sometimes even requiring corrective surgery.

What are hammer toes?

The condition commonly referred to as 'hammer toe' actually encompasses three different but closely related conditions:

• 'Classic' hammer toe - This affects the proximal interphalangial joints (the middle joints) on the second, third or fourth toe, and causes them to become deformed and permanently bent, resembling the eponymous hammer.
• Mallet toe - This has the same symptoms, but affects the distal interphalangeal joints (the joints furthest from the ball of the foot) of the second, third, fourth or fifth toe.
• Claw toe - Claw toes suffer the deformities of both hammer toes and mallet toes, combined with an involuntary raising of the toe at the metatarsophalangeal joint where the toe meets the rest of the foot. This results in the characteristic hooked appearance, resembling a question mark, and is rarer and more debilitating than the other two conditions.

All of these conditions can cause partial or total immobility of the affected toe, and all can become excruciatingly painful over time, particularly while wearing shoes. The altered foot mechanics caused by these conditions also frequently result in calluses, bunions and corns to form 

What causes these conditions?

Despite the differences in symptoms, all the conditions that come under the hammer toe umbrella have the same basic causes:

• Ill-fitting shoes - Shoes that are too short cause the toes to be constantly bent. Shoes that are too narrow force the toes into each other, pressing one or more of them down into an unnaturally bent position. Both these problems can eventually result in hammer toe conditions.
• High heeled shoes - Wearing high heels for extended periods can place enormous stresses on the toes, causing them to contract and bend.
• Diabetes - The nerves in the feet are commonly affected by this chronic condition, and can be exacerbated by tight shoes and poor foot care. Toes with damaged nerves may become involuntarily bent, and are usually very painful to walk on.
• Arthritis - Hammer toe is commonly associated with both osteoarthritis and rheumatoid arthritis, and are likely to be much more painful than the hammer toes of non-sufferers due to the increased pressure on the joints.
• Other causes of nerve and muscle damage - Various chronic conditions can cause widespread muscle and nerve damage. Damage can also be caused by acute conditions such as strokes, or by external injuries from physical activities such as sports (rock climbing is a common culprit here). Drug abuse and alcoholism have also been linked with muscle and nerve damage resulting in hammer toes.
• Congenital and idiopathic causes - Sometimes a hammer toe develops with no immediately obvious reason. On occasion babies are born already suffering from one or more hammer toes - the cause of this is currently unknown. 

How can I treat hammer toes?

• Physical therapy - Appropriate in cases where the affected toe(s) retain limited flexibility, physical therapy, combined with other measures, can often restore full functionality to a hammer toe. Usually this consists of stretching the shortened tendons which force the toe to bend, and may take several months to be fully effective. Patients can also practise grabbing and lifting objects with their toes to increase overall strength and flexibility.
• Spacious shoes - Often a patient will seek treatment for hammer toes, without changing the constricting shoes that are causing the ailment. Often, a properly-fitted pair of standard shoes will be enough to reverse the problem, but specialised orthopedic shoes with wider or taller toe boxes are also available for more advanced cases.
• Custom insoles - These contoured insoles are made to fit around the hammer toe by a professional podiatrist, and reduce pain and discomfort. They do not, however, help reverse the condition.
• Surgery - This option is generally only recommended for very advanced cases in which the toe retains no movement of flexibility - however, it is often the only course of action to correct a claw toe. Generally, the surgeon will either make a small incision in the contracted tendon(s) to release the pressure, or else cut out a small piece of bone from the affected joint and use the extra room to straighten and align the toe. The affected toe is then braced with metal pins to keep it straight during rehabilitation. During the healing process, you may be required to wear a special shoe with non-flexible soles to keep the toe straight. The toe will generally be fully healed after three weeks to a month, and in most cases full functionality of the toe returns.