can occur when feet are crammed into shoes so tight that the
front of the toes are pushed against the front of the shoes for prolonged periods of time. One or more toes then remain bent with the middle knuckle pointing up, even when shoes are taken off. If the
condition is left untreated and tight footwear is continually worn, these bent toes can become so rigid that they can no longer straighten out on their own. While any shoes that are too tight can
lead to this condition, high heels seem to be a big culprit since the elevated ankle causes more weight to push the toes forward. This may explain why the condition affects more women than men.
Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don?t fit well can crowd the toes, putting pressure on the middle toes and causing
them to curl downward. Other causes include genes. Some people are born with hammertoe, bunions. These knobby bumps sometimes develop at the side of the big toe. This can make the big toe bend toward
the other toes. The big toe can then overlap and crowd the smaller toes. Arthritis in a toe joint can lead to hammertoe.
The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead
of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe
is usually flexible, but when longstanding it becomes more rigid.
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear
crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at
the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still
flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the
involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
Padding and Taping. Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes Hammer toe
pain and allows the patient to continue a normal, active life. Taping may change the imbalance
around the toes and thus relieve the stress and pain. Medication. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.
Orthotic Devices. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe
For severe hammer toe, you will need an operation to straighten the joint. The surgery often involves cutting or moving tendons and ligaments. Sometimes the bones on each side of the joint need to be
connected (fused) together. Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter. If the condition is treated early, you can
often avoid surgery. Treatment will reduce pain and walking difficulty.