Author: Dr. Craig Halihan
Hammer toes is a chronic arthritic deformity that affect the small joints of the toes. When the joint close to the foot is affected, it is known as a hammer toe. When the joint close to the nail is affected, it is known a mallet toe. When both joints are affected it is known as a claw toe. These often painful deformities can be either very rigid and cannot be passively reduced, or flexible and can be reduced using gentle manual manipulation. The more rigid the deformity, the less conservative treatment will be effective. When the deformities become more rigid, they tend to be more painful.
Hammer toes are often the result of poorly fitting shoes, years of high heel use, flat feet and very high arched feet. In fact mild flexible cases often respond to a simple change of shoe type or size. Hammer toes can also result form injuries or neuromuscular conditions and diabetes. Hammer toes are also often associated with bunion deformities. When the great toe begins shifting toward the smaller toes they often run out of space and are forced into an upward position to accommodate the new position of the great toe, resulting in a hammer toe deformity.
Signs and symptoms of hammer toes are typically:
- painful corns and calluses on the peak of the joint or on the bottom of the foot.
- Pain and limited range of motion of the joints.
- Claw like or bent appearance of the toe at one or both of the joints.
It is recommended that you see a doctor if pain is constant or affects your ability to walk or wear shoes. Check ups are also recommended for people suffering form associated bunion deformities or in cases where multiple toes are affected.
Treatment depends on the degree of rigidity and pain.
- Flexible and non-painful deformities: treated with conservative strapping or a change in shoes. Sometimes accommodative padding can be employed.
- Flexible but painful deformities: treated sometimes with strapping and padding, but sometimes a tendon release may be necessary to relieve pain. This can be done with a simple small incision and tendon release. There is often a short recovery period, ambulating in a surgical shoe for 2-3 weeks.
- Rigid painful deformities: these rarely respond to conservative treatment, but generally respond very well to a surgical approach. Arthroplasties are used to reshape and straighten deformed toes. This returns them to a straight non painful position. Sometimes in cases where the deformity is really bad, joint fusions may be required to relieve pain and return the toe to a straight position.
It is usually a good idea to treat any other contributing deformities, such as bunions or flat feet. A good consultation with your doctor, will shape your treatment options and answer all of your questions.
