What is a Hammer toe?
A hammer toe is the most common lesser toe deformity, followed by claw toes and mallet toes. A hammer toe occurs when one or both joints in your little toes are bent, or contracted. These usually affect the second toe and are often seen in conjunction with a bunion, as the big toe pushes on the second toe.
Signs and Symptoms of Hammer toes
Hammer toes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammer toes are flexible and the symptoms can often be managed with conservative treatments. But if left untreated, hammer toes can become more rigid and begin to overlap other toes. At this point conservative treatments become less affective, so its important to seek advice from a podiatrist when you first notice any changes. Some other signs and symptoms include:
- Pain, irritation, swelling or redness of the affected toes when wearing shoes
- Corns: (small areas of thickened skin) on the top, side, or end of the toe, or even between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
- Calluses: (general thickening of the skin) on the bottom of the toe or on the ball of the foot.
- Limited movement of the affected toes.
- Trouble wearing shoes
Causes of Hammer toes
The most common cause is an imbalance in the muscles and tendons in the toes, causing the toes to bend. This commonly results from wearing short, narrow shoes that are too tight for your feet, causing your toe(s) to be forced into a bent position, resulting in the muscles and tendons in the toe to tighten and become shorter. Other causes of hammer toes include:
- Foot type: excessively flat feet (pronated) or high arch (supinated) feet can also cause lesser toes deformity. Due to the foot being in an unstable position, the lesser toes have a tendency to want grip the ground to improve stability. Long periods of this action can cause the position to become permanent.
- Hereditary: Studies have shown that genetics may play a role in this deformity.
- Injury (breaking the toe or stubbing the toe).
- Nerve damage: this is often seen in diabetic peripheral neuropathy
- Pressure from a bunion
- Wearing improper footwear: particularly high-heeled shoes and shoes with a narrow toe-box
Preventing Hammer Toes
- Avoid shoes with pointed or narrow toes.
- Avoid shoes that are too tight or short.
- Avoid wearing high-heeled shoes higher than 5cm. These can force the toes forward into a clawed position.
- If the shoes hurt, don’t wear them.
- Choose shoes with wide toe box.
- Choose shoes that are a half-inch longer than your longest toe.
- Always have your shoes fitted by an experienced shoe-fitter or a podiatrist.
- Perform toe exercises to maintain healthy muscle balance: a podiatrist can prescribe the specific exercises relevant to you.
- If you notice you are developing hammer or claw toes, do not let them progress into a rigid deformity.
There are several conservative treatment options for hammer toes and other lesser toe deformities. Our team will select treatments specific to you and these will depend on the symptoms you are experiencing, the severity of your hammer toe, previous treatments and other factors.
A number of non-surgical treatment options are available for hammer toes including:
- Trimming corns and calluses: This should be done by a podiatrist. Never attempt to do this yourself, because cuts and infection are a common occurrence. A podiatrist is skilled in using the best techniques to remove corns to bring you the greatest benefit.
- Padding corns and calluses: We can provide, prescribe and fabricate pads designed to prevent corns and shield them from irritation. If you want to try over-the-counter pads, we recommend you avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful, particularly if you have diabetes.
- Wearing adequate footwear: Avoid pointed shoes, shoes that are too short, or shoes with high heels. Such shoes can force your toes against the front of the shoe, causing them to bend. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
- Orthotic therapy: a custom orthotic device placed in your shoe may help control the muscle/tendon imbalance, particularly for those who have unstable foot types (i.e. flat or high arched feet).
- Injection therapy: Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammer toes if it has been un-responsive to conservative treatments.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be prescribed to reduce pain and inflammation via your GP.
- Splinting/strapping: Splints or small straps may be applied to realign the bent toe.
Surgery for Hammer toes
If your hammer toe is treated early, you can often avoid the need for surgical correction. Once the hammer toe becomes rigid or if you develop severe pain or ulcers that are non-repsonsive to conservative treatment, surgery may be needed.