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Conditions

Hammer toe

What is hammer toe?

Hammer toe is a physical deformity resulting from a lack of alignment of the muscle and ligament over the toe joint. The affected toe is forced into a bent position and remains fixed, unable to straighten.

What causes hammer toe?

Poorly-fitting shoes and high heels that force the foot into an unnatural position are the main causes of hammer toe, which can occur in any toe. This unnatural bend in the toe can cause rubbing and irritation on the top of the toe joint, leading to blisters and corns. Patients with diabetes or poor circulation may experience serious complications from hammer toe.

Typical diagnosis

A typical diagnosis consists of a physical exam of the foot, followed by an X-ray to look at the bones of the feet. Doppler ultrasound may also be used to evaluate blood flow to the foot, if circulation is a concern. The doctor will inquire if the patient has a history of foot problems, arthritis, circulation, symptoms, and what type of shoes are worn every day.

Symptoms

Abnormal bend in the joints of one or more of your toes
Movement is difficult or painful
Development of corns and calluses

Treatments

The doctor may recommend non-invasive treatment methods for flexible hammer toe, such as wearing shoes that fit well and have plenty of room in the toe box, as well as a low heel. Orthotic shoe inserts may be used to reposition the toe and lessen foot pain by inhibiting the toe from rubbing on the shoe and becoming irritated. Custom orthotic shoes may provide relief from hammer toe pain.

Non-invasive treatments

Moleskin

Hammertoe may lead to the development of corns or calluses, which can be treated with over-the-counter remedies (like Moleskin) to relieve pain and irritation. Cutting corns or calluses is not recommended, as this may cause infection.

Taping or splinting

Application of tape to align the hammertoe to the straight toe next to it, maintaining a straightened position.

Toe caps or slings

Gel toe caps can help to eliminate friction between the shoe and the toe.

Toe exercises and stretching routines

Toe exercises make the toe more flexible and strengthen the muscles, which results in better alignment. Toe exercises are performed by carefully pulling the toes, one at a time, to stretch the bent joints, maintaining the stretch for a few seconds. Using the toes to pick up objects, such as marbles, or placing a towel flat under the feet and employing the toes to scrunch it also increases strength and benefits muscle alignment.

Treatments (cont.)

Surgical solutions

If hammertoe is severe and unresponsive to noninvasive treatment, causing significant pain or deformity, surgery may be an effective treatment option. Depending on the type of hammertoe you have, the surgical solutions may vary.

Flexible Hammertoe

If your hammertoe is flexible and your surgeon can straighten the toe, a tendon transfer procedure may be used. This procedure involves rerouting the tendons from the bottom of the toe to the top of the toe, which helps pull the bent joint into a straight position.

Fixed Hammertoe

If your hammertoe has become fixed (stiff), there are two options for treatment: joint resection or fusion.
Joint resection is a procedure where an incision is made over the top of the toe. Ligaments and tendons may be cut to help with straightening the toe. The end of the bone is removed to allow the toe to straighten completely, and pins are temporarily used to hold the toe straight.

With a Fusion procedure, the ligaments and tendons are cut to help straighten the toe, then the ends of the bone are cut, and the toe is straightened. Pins, screws or other implants can be used temporarily to keep the toe straight while the bone ends heal together.

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