Patients and doctors often refer to all forms of toe abnormalities as a hammertoes
. There are in fact four main forms of toe
abnormalities, hammer toes, claw toes, mallet toes and trigger toes. A hammertoe can be best described as an abnormal contraction or "buckling" of a toe. This occurs due to a partial or complete
dislocation of one of the joints that form the toe. As the toe continues to be deformed, it will press up against the shoe and may cause corns.
The main cause of hammer toe is poorly fitted and/or poorly designed footwear. Any footwear that is too tight in the toe box, especially high-heeled shoes, can push the toes forward, crowding one or
more of them into a space that is not large enough to allow the toes to lie flat and spread as they should. Other causes include the following. Changes in foot anatomy. Sometimes the metatarsal
bones in the ball of the foot can ?drop,? creating a situation in which the toes do not make
contact with the surface of the shoe. The toes may then contract at one or both of the joints to re-establish contact with the surface. Traumatic injuries in which toes are jammed or broken. Diabetic
neuropathy. This can cause abnormal foot biomechanics due to nerve and/or muscle damage. Damage to nerves and muscles from other conditions, such as arthritis or stroke. Heredity.
Common reasons patients seek treatment for toe problems are toe pain on the knuckle. Thick toe calluses. Interference with walking/activities. Difficulty fitting shoes. Worsening toe deformity. Pain
at the ball of the foot. Unsightly appearance. Toe deformities (contractures) come in varying degrees of severity, from slight to severe. The can be present in conjunction with a bunion, and develop
onto a severe disfiguring foot deformity. Advanced cases, the toe can dislocate on top of the foot. Depending on your overall health, symptoms and severity of the hammer toe, the condition may be
treated conservatively and/or with surgery.
Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and
evaluate your gait as you walk and the types of shoes you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor
can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.
Non Surgical Treatment
To keep your hammertoes more comfortable, start by replacing your tight, narrow, pointy shoes with those that have plenty of room in the toes. Skip the high heels in favor of low-heeled shoes to take
the pressure off your toes. You should have at least one-half inch between your longest toe and the tip of your shoe. If you don't want to go out and buy new shoes, see if your local shoe repair shop
can stretch your shoes to make the toe area more accommodating to your hammertoe.
Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe
problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and
ligament abnormalities that define each hammertoe's make-up. To correct a hammertoe deformity, the surgeon's goal is to restore the normal alignment of the toe joint, relieving the pressure that led
to the hammertoe's development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or
loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use
screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.