Hammer Toe

Hammer toe is a painful foot deformity in which one or more of the toes is permanently bent, somewhat resembling the shape of a hammer. This usually happens in the second, third, or fourth toe.  In technical terms, the proximal interphalangeal joint of the affected toe has become deformed. The toes can curl up and resemble a claw. The condition becomes painful when the toe’s shape forces it to press against the other toes unnaturally, or against the inside of the shoe. Hammer toe commonly is associated with other foot conditions such as bunions and corns. Pain can be centered on the top or tip of the toes, or on the ball of the foot.

Hammer Toe

Hammer Toe on 2nd digit

Hammer toe is sometimes a genetic disorder that develops due to foot conditions such as flat feet or high arches. It can be related to an arthritic condition as well, and can be symptomatic of a stroke. However, often the problem develops as a result of poor fitting shoes. Women especially can develop hammer toes if they wear tight fitting high heeled shoes for long periods.

Muscles that control the toes work in pairs, and if the muscles become imbalanced it can cause stress on the tendons, nerves, and joints of the toe. This stress can be force the toe into the bent hammer shape. In its initial stage, the hammer toe is still flexible and can be moved, although it is often painful. There are treatment options that we will discuss for this. In later stages the hammer toe’s tendons have become rigid and stiff and cannot be moved. For this case surgery is often the only viable option.

Physical therapy is sometimes effective for the flexible hammer toe condition. This therapy usually focuses on exercising the toes by using them to pick up small objects off the floor. These exercises will strengthen the toe muscles and stretch them out.  In addition, a brace can be fitted that will force the muscles of the toes to stretch out. For relieving the discomfort of hammer toe, padding of the toe is recommended. Cortisone injections and orthotics are helpful in many cases. OTC anti-inflammatories can be effective also. Wearing shoes that have excessive toe room to accomodate the curled toe(s) is beneficial. Using open toed shoes that don’t put pressure on the toes is ideal.  Some helpful treatment aids can be found here on this website.

If surgery is deemed necessary, it is often to release the tight tendon that is keeping the toe from being able to stretch out. The toe can be surgically shortened also. The bone structure can be modified around the toe joint to allow for additional movement. Some hardware may be implanted in the toe which will allow the bones, tendons, and ligaments to recover.  Laser surgery is not usually an option since bone procedures are usually part of the surgery.

Recovery time is highly dependent on the exact nature of the surgery, but the healing process is normally around 6 weeks. Patients can usually walk in surgical stiff soled shoes shortly after the procedure. Return to normal footwear and activities can be anywhere from 1 to 3 months. Surgery on the second toe is generally more involved, since it is more actively involved in pushing off when walking, and the recovery is longest for this toe. Bunions can be treated if necessary at the same time, which can lengthen the recovery time. The surgery is normally done as an outpatient procedure.




— Image courtesy footandankleinsitute.be