A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is abnormally curled due to a bend in the middle joint of a toe.
People with hammer toe may develop painful corns or calluses on the top of the middle joint of the toe or on the tip of the toe. Finding comfortable shoes may become very difficult, and walking may become painful.
Hammer toe can be inherited and present from birth, however it is commonly caused by wearing poorly fitting shoes, including shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like appearance.
A simple measure of relieving the pain and pressure of hammer toe is changing your footwear. However, in more severe cases of hammer toe, surgery may be needed.
Symptoms
Hammer toe deformity can have no symptoms aside from the deformity itself. In many people, the deformity is accompanied by:
- Pain – this can occur in both the joints of the deformed toe and in other joints in the foot and ankle. This is due to abnormal walking patterns that develop to adapt to the deformity.
- Tough calluses form over the knuckles of the toe as they rub against your shoes. Occasionally these split and become ulcers.
Hammertoe deformity may be either flexible, where the toe can be straightened with the hands, or stiff (rigid).
Causes
Hammer Toe occurs when the forces acting around the joint are not balanced. There are many reasons that this can occur, including shoes putting pressure across the joint or other deformities in the foot.
- Inherited. Some people are born with hammer toe deformity that may worsen over time.
- Acquired hammer toe can be due to:
- Poor footwear
- Other deformities in the foot or ankle. These disturb the balance of forces around the toe.
- Long toes
- Arthritis and nerve dysfunction, like diabetes and Charcot-Marie-Tooth disease
Risk Factors
- Other deformities in the foot or ankle, including pes planus (flatfoot), pes cavus, metatarsus adductus
- Long toes
- Family history of toe, foot and/or ankle deformities
- Arthritis
Investigations
Your GP or podiatrist can usually tell you have a hammer toe just by looking at your foot and feeling it. Two things are checked.
- Whether the toe is still bendy. The doctor will try to straighten the toe by hand. A toe that still straightens is treated differently from one that has gone stiff.
- Where the pressure is. Corns and hard skin show where the toe is rubbing inside your shoe.
An X-ray may be taken to look at the bones and the way the toes line up, especially if surgery is being thought about.
If you have diabetes or poor circulation, the feeling and blood flow in your foot will also be checked. This is because skin problems on the toe heal less easily.
Complications
Untreated hammer toe may progress to more severe deformity, and from flexible to stiff deformity. As the deformity worsens, the risk of developing other complications, like ulcers, calluses, arthritis in other joints and an abnormal gait increases. The deformity may also lead to disease in the nail, including ingrown and broken nails. All of these factors can lead to worsening pain and difficulty walking.
Occasionally, ulcers that form around the deformed toe can become infected. The infection can spread into the soft tissues deep to the skin, and even spread into the bone causing osteomyelitis. This is a rare serious complication that is more common in diabetics.
Treatment
Normally, hammer toe is treated without surgery. Your doctor can suggest
- Different footwear – this will sometimes involve referral to an orthotist. Generally, wide padded shoes help to relieve the symptoms and potentially correct the deformity.
- Pain medication. Occasionally injections of steroids into the joint can relieve inflammation.
If the deformity is due to an underlying condition like arthritis this will require its own treatment. Deformities associated with diabetes will often require referral to a podiatrist.
Surgery for hammer toe is indicated when
- The deformity is causing significant symptoms that are not relieved by non-surgical measures. ‘Significant symptoms’ can be defined in many ways, but generally substantial impact on life and work are the key considerations.
- The patient is able to cope with surgery. Generally, surgery becomes more dangerous in the elderly, and in those with significant heart and/or lung disease. Surgery will always be preceded with pre-operative testing to confirm that the patient is fit for surgery.
The operation to correct hammer toe is generally fairly minor and able to be performed without keeping the patient overnight. This varies depending on individual cases and should always be discussed with your surgeon.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Wearing well-fitting and comfortable shoes is very important to protect your feet from developing deformities. It is also important to take care of your feet and see your GP or other health care provider as soon as you notice any deformities.
F.A.Q. | Frequently Asked Questions
What is the difference between a hammer toe, a claw toe and a mallet toe?
They are named for where the toe bends. A hammer toe bends down at the middle joint. A claw toe bends up at the joint where the toe meets the foot and down at both joints beyond it. A mallet toe bends down at the joint nearest the nail.
Will it straighten on its own?
No. Hammer toes do not correct themselves and tend to get slowly worse. Early on the toe can still be pushed straight by hand. Later the joint stiffens and stays bent.
Do I need an operation?
Most people do not. Surgery is for a toe that stays painful in spite of roomy shoes and padding, or where a corn or sore keeps coming back.
What shoes should I wear?
Shoes with a deep, wide, rounded toe box and a low heel. You should be able to press above your toes without feeling them touch the top. See footwear in orthopaedics.
Do toe straighteners and splints work?
They can make a bendy toe more comfortable and take pressure off a corn. They do not straighten a toe for good, and they do not work once the joint is stiff.
Can I cut the corn off myself?
It is safer to have corns trimmed by a podiatrist. Corn removers bought over the counter contain acid and can damage healthy skin. This matters most if you have diabetes or poor circulation.
How long does recovery take after surgery?
The toe stays swollen for several months, which is normal. Most people are back in ordinary shoes somewhere between six weeks and three months.
References
Barakat, M. J., et al., ‘Curly toe, hammer toe, claw toe and mallet toe: are they good descriptive terms of the associated deformities of the lesser toes?’, European Journal of Orthopaedic Surgery & Traumatology, Vol. 15, 2005, pp 226–228.
Mann J. A., et al., “Chapter 9. Foot & Ankle Surgery”, Skinner HB: CURRENT Diagnosis & Treatment in Orthopedics, 4e: http://www.accessmedicine.com/content.aspx?aID=2321540.
Schuberth, J. M., ‘Hammer Toe Syndrome’, The Journal of Foot and Ankle Surgery, Vol. 38, No. 2, March/April 1999, pp. 166–178.