The Institute for Foot and Ankle Reconstruction at Mercy – Baltimore, MDHammer toe is a deformity involving the lesser toes. In a hammer toe, the joint in the middle of the lesser toe bends downward and becomes crooked. This is often accompanied by elevation of the joint at the base of the toe. The second toe is most commonly involved because this toe is often the longest, but any of the lesser toes may be affected.
The most frequent cause of hammer toe is tight fitting shoes or high heels that compress the toes into a narrow toe box. When the toes are repetitively held in this position, the tendons and ligaments eventually become stiff which makes the deformity permanent.
Another common source of hammer toes is the presence of a bunion. As the big toe shifts toward the outer side of the foot, the second toe is pushed upward leading to the deformity. The causes of hammer toe include:
• Tight fitting shoes
• High heels
• Bunion (deformity of the big toe pushes on second toe)
• Injury to the toe
• Rheumatoid arthritis
• Imbalance of the muscles controlling the toes
Patients with hammer toes often complain of pain on the top of the toe over the prominent knuckle where they can experience redness, irritation, and calluses. Symptoms of hammer toe include:
• Calluses and pain along the top of the toe
• Redness and irritation on the top of the toe
• Difficulty with shoe wear
• Pain or discomfort under the ball of the foot
• May develop into ulcers in patients with diabetes
The orthopedic foot and ankle specialist will examine the hammer toe to determine if the deformity is flexible or rigid. It is also important to assess the entire forefoot to look for other problems that should be treated along with the hammer toe. This will help determine the type of procedure to perform if surgery is required. X-rays can help identify signs of trauma, arthritis, and other deformities in the forefoot.
Conservative Treatment Options
Non-surgical treatment can include:
• Switching to shoes with a high, wide toe box
• Silicone toe sleeves that cover the top of the lesser toe
• Felt pads with a hole cut out in the middle to protect the hammer toe
• Strapping or taping the toe in a straighter position
Flexible hammer toe deformities can be treated with a procedure that removes a small portion of bone in the proximal phalanx of the toe. This relaxes the abnormal tension of the tendons and ligaments in the lesser toe allowing for correction of the toe deformity. A temporary metal pin may be placed across the joint to hold the correct alignment. This wire is usually removed in the office.
Rigid hammer toe deformities often require a bony procedure called a fusion. The deformed toe joint is opened and the cartilage is removed. The bones on either side of the joint are compressed together either by a device implanted inside the bone or by a simple pin that extends out the tip of the toe. The two bones will eventually heal together into a single straight bone.