Hammer toe

Types

There are three types of hammer toe, as categorized by podiatrists.

• Flexible hammer toes are where patients are still able to bend and move the affected toes, but where a noticeable curl has begun to form.

• Semi-rigid hammer toes are where the affected toes are hard to bend and are noticeably stiff.

• Rigid hammer toes are frozen in a curled position. These are most likely to require surgery.

Risk factors

Older people are more likely to develop hammer toes. Women are at higher risk, due to the construction of women's shoes.

Causes

Hammertoes and clawtoes have multiple causes. Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems (e.g., a bunion can force the big toe to turn inward and push the other toes).

The toe muscles work in pairs; if the muscles pulling in one direction are much weaker than those pulling in the other direction, the imbalance can bend the toe. If the bend persists, then as the tendons and ligaments tighten (as they do if not stretched), the bend may become permanent. Ill-fitting shoes are especially likely to push the toes out of balance.

Toe deformities can also be caused by muscle, nerve, or joint damage, resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia (GAA trinucleotide repeat).

Treatment

In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while in more severe or longstanding cases hammertoe surgery may be necessary to correct the deformity. The patient's doctor may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor.

References

References

1. Sabrina Felson. "Understanding Hammertoes – the Basics".
2. [https://www.mayoclinic.org/diseases-conditions/hammertoe-and-mallet-toe/symptoms-causes/syc-20350839 Mayo Clinic, "Hammertoe and mallet toe"]
3. "Hammertoes".
4. "Hammertoe".
5. (December 2011). "Hammertoes/Clawtoes: metatarsophalangeal joint correction.". Foot and Ankle Clinics.
6. (December 2011). "Hammertoes and clawtoes: proximal interphalangeal joint correction.". Foot and Ankle Clinics.
7. "Hammer Toe: Comprehensive Guide – OrthoInfo – AAOS".
8. "Benefits and Risks of Hammertoe Surgery".