What Is Hammer Toe?
The smallest four toes of each foot have three bony segments connected by two joints, just as the fingers do. Hammer toe is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments so that the tip of the toe turns downward, making it looks like a hammer or claw. The second toe is affected most often.
Most hammer toes 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. The condition may be more likely when the second toe is longer than the first toe or when the arch of the foot is flat. Hammer toe can also be present at birth (congenital). Hammer toe also can be caused by a bunion, which is the knobby bump that sometimes develops at the side of the big toe. A bunion causes the big toe to bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Occasionally, a hammer toe is inherited or caused by arthritis in the toe joint.
If the toes remain in the hammer toe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when shoes are not being worn.
Symptoms of hammer toe
The symptoms of hammer toe include:
- A curling toe
- Pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward
- Thickening of the skin above or below the affected toe with the formation of corns or calluses
- Difficulty finding shoes that fit well
In its early stages, hammer toe is not obvious. Frequently, hammer toe does not cause any symptoms except for the claw-like toe shape.
Diagnosis of hammer toe
Most health care professionals can diagnose hammer toe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammer toe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammer toe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).
Unless treated, hammer toe is permanent.
Prevention of hammer toe
Most cases of hammer toe can be prevented by wearing shoes that fit properly and give the toes plenty of room. Some recommended guidelines include:
- Avoid shoes with pointed or narrow toes.
- Avoid shoes that are too tight or short.
- Avoid high-heeled shoes, which can force the toes forward.
- If the shoes hurt, don’t wear them.
- Choose shoes with wide or boxy toes.
- Choose shoes that are a half-inch longer than your longest toe.
If you notice the beginning signs of hammer toe, you may be able to prevent the tendons from tightening by wearing toe-friendly shoes, by flattening your toes regularly, and by soaking your feet every day in warm water, then stretching your toes and ankles by pointing your toes.
Foot exercises also can help to maintain or restore the flexibility of the tendons. One simple exercise is to place a small towel on the floor and then pick it up using only your toes. You also can grasp at carpet with your toes or curl your toes up and down repeatedly.
Treatment of hammer toe
Treating hammer toe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include:
- Splinting the toe to keep it straight and to stretch the tendons of the foot
- Using over-the-counter pads, cushions or straps to decrease discomfort
- Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises)
- Wearing shoes that fit properly and allow toes plenty of room to stretch out
In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat.
When To Call Us
Make an appointment with us if you experience pain in your toes or feet that lasts longer than several days. If one or more of your toes begins curling, see our doctor to discuss early treatment to avoid hammer toe. If you already have hammer toe and find it bothersome, call us for an evaluation.
Hammer toe is often a harmless and painless condition. Although the toe may be curled permanently, hammer toe should not cause any long-term problems other than a more difficult time finding shoes that fit. If hammer toe is treated and preventive measures are followed, the condition should not return. Wearing tight or constricting shoes can cause hammer toe to return.