Hammertoes

Hammertoes are raised circular bumps that appear on the knuckles of toes. They are ultimately caused by an imbalance of the small muscles, tendons, and ligaments that keep the toe straight. A hammertoe occurs when one or both toe joints bend downward and most commonly occurs to the 4 smaller toes, often sparing the great toe.

A hammertoe usually causes pain in closed shoes and can make walking difficult. They can be painful when you try to stretch, bend or flex the toe as well. Sometimes a hard callous build up of dead skin can develop on top of the toe called a corn. There also may be swelling, redness or a burning sensation on top or in between the toes.  These outward changes seen on the toe develop due to friction between the top of the toe and the inside toe box of the shoe. A podiatrist usually can diagnose a hammertoe during clinical examination. X-rays are routinely performed help to determine how rigid or flexible the hammertoe is and visualize arthritic changes or spurring.

A very common cause of this condition occurs from imbalances resulting from foot structure, such as when the second toe is longer than the great toe. Longer toes tend to jam into the toe box while walking and running and eventually will cause hammering. Hammertoes may also run in families and are can associated with aging.  Injuries, such as broken, stubbed or jammed toes may be more likely to develop hammertoe contractures from damage to the joints. People with flat feet, high arch feet and diseases such as arthritis, diabetes and certain neurological conditions are also more prone to develop hammertoes as well.

Hammertoes usually develop over time, is a progressive condition and many are thought to be caused by ill-fitting shoes such as pointed heels. Over use of tight shoes or high heeled shoes for long periods of time, and long periods of standing and walking in heels can cause the toes to become bent and contracted.  Women are more likely to develop hammertoes, largely to the shoes they wear.

There are different types of hammertoes. Some hammertoes can be flexible, while others are more rigid. If the toe can be moved at the joint into a straight position that is a good sign and there are some helpful non-surgical treatment options.  Conservative treatments such as shoe gear changes, padding, cushioning, and orthotics are often initially recommended.  Having your podiatrist shave down, or inject cortisone into an associated painful corn can also give immediate relief.  Icing, strengthening and stretching exercises may also be prescribed when the hammertoe is flexible.

When the toe progresses from flexible to rigid and it cannot be moved into a straight position, conservative measures are less likely to work. Many of these patients may require hammertoe surgery where a small bony portion of the contracted joint is removed in order to straighten the toe. This is routinely performed on an outpatient basis at a surgical center or hospital and has a recovery period of approximately 3 weeks.