When you lay your feet flat against the floor, you expect your toes to point straight forward and sit perpendicular to the floor’s surface. In the case of a foot with hammertoes, one or more toes will curl downward instead, so that your middle toe joint resembles that of a hammer. This happens when the ligaments and muscles around the middle toe joint buckle and get stuck. While this is a common deformity that typically affects the second, third, or fourth toes, it can be seen in all toes.
Flexible & Rigid Hammertoe Types
You can tell which type of hammertoe you have by simply seeing if you can move the toe. If you are able to move your toe at the middle joint, this is a flexible hammertoe. This is a mild form of the deformity and can be treated without surgery.
If the tendons have become too rigid and the joint has been pressed out of alignment, you aren’t going to be able to move your toe. If this is the case, this is a rigid hammertoe and often requires surgery to fix.
Symptoms of the above types of hammertoes include swelling and redness, inability to straighten the toe, pain when moving or earring shoes, difficulty walking, and corn or calluses on the top middle joint of the toe.
What Causes Hammertoes in the First Place?
A hammertoe forms as a result of a muscle imbalance within the toe. The muscles or tendons in your toes work in pairs to straighten or bend the toe as needed. If the toe ends up being bent either upward or downward for too long, the muscles will tighten up and become stuck. Since they cannot stretch out, you end up with an imbalance and a middle joint that buckles. There are a few situations that can cause this imbalance:
1. You have arthritis in the toes that cause changes in the middle joint.
2. You have been using poorly fitting footwear for a prolonged period.
3. You have unstable foot posture, which results in the overuse of your toes. If you have excessive contraction of the muscles/tendons in your toes, this can cause hammertoes. This is seen in individuals who excessively roll-in (pronation) or excessively roll-out (supination) their toes.
The most common cause of this imbalance is wearing ill-fitting shoes. If shoes are too narrow, they may push the smaller toes into a bent or flexed position for a long period of time. The toes may also rub against the inside top of the shoe, causing calluses or corns to form, which aggravates the hammertoe. If you wear a lot of high heels, this forces the foot downward, placing pressure on the toes and bending them.
How to Prevent Hammertoes From Forming?
The main way to keep hammertoes from forming is to control any bone or muscle imbalances that could occur due to malalignment. What this means is that you need to wear proper fitting shoes at all times, so that there isn’t too much pressure being placed on your toes, forcing them to be in a bent position for long periods of time. Here are some basic tips for purchasing well-fitting shoes:
● Have one-half inch between your longest toe and the end of your shoe.
● Avoid pointy, narrow toe boxes.
● Look for shoes that have good arch support.
● Fit and purchase your shoes at the end of the day. Your feet will swell throughout the day, giving you a better indicator of what is comfortable.
● Pay attention to how your feet fit in the shoe. The shoe size may not always be the best indicator of whether a shoe is right for you.
If you fall in love with a pair of shoes, but they are a little bit tight, don’t purchase them expecting them to stretch as you wear them. This is only going to increase your risk of developing hammertoes.
What are the Treatment Options for Hammertoes?
If you have a flexible hammertoe, where the middle joint is still flexible, then you can expect the following treatment recommendations:
1. Purchase new footwear. You will need to change your footwear from tight, narrow shoes, to ones that have a roomy toe box. You may need to avoid wearing certain kinds of shoes until the hammertoe has been fixed; such as: high heels, cleats, and shoes with pointy toe boxes. Furthermore, you may need to wear sandals for the time being.
2. Engage in toe exercises. Your doctor may recommend that you stretch your toes out manually on a daily basis or spend time picking items up with your toes. You may be told to practice toe curls to help strengthen the tendons.
3. Non-medicated cushions. If your hammertoes come with calluses or corns on the top of the middle joint, you may be prescribed non-medicated corn pads or cushions to relieve pressure and pain on the joint.
If you have a rigid hammertoe, where the toe can no longer move properly, then surgery is often recommended. Depending on the severity of the hammertoe, you will receive one of the following treatment options:
1. Tendon lengthening. This is often done on more flexible hammertoes that have severe deformities, as it eliminates the joint imbalance by creating longer tendons.
2. Tendon transfer from bottom to top. One way to pull the buckled middle joint up is by transferring tendons from the bottom of the toe to the top, to help pull the joint into place.
3. Joint fusion (arthrodesis). With this kind of procedure, the surgeon will remove a small portion of the middle joint where it is inflexible. An external wire, pin, or internal plate will hold the bones together until they fuse together. This allows the toe to fully extend. It is often done in combination with tendon lengthening.
If you require surgery to fix your hammertoes, the recovery time is about 4-6 weeks. Expect to have swelling, stiffness, and redness in the toe until fully healed. It is recommended to elevate your foot and limit activity during the healing process.