A hammer toe is a common foot deformity affecting the second, third, or fourth toe, where the toe bends abnormally at the middle joint, causing it to resemble a hammer. This progressive condition can make wearing shoes difficult and often leads to painful corns or calluses forming on the affected joint.
Understanding the Condition and Its Causes
The deformity results from a chronic imbalance in the muscles, tendons, and ligaments that maintain the toe’s straight alignment. When this delicate balance is disrupted, the flexor tendons overpower the extensors, pulling the middle joint (proximal interphalangeal joint) into a flexed position. This misalignment creates increased pressure on the toe during walking and inside footwear.
Ill-fitting shoes are a primary contributing factor, especially high heels or shoes with a narrow toe box that crowd the toes into a bent position over time. Other factors include foot structure, such as having a high arch, a bunion, or a second toe that is longer than the big toe. The condition is initially classified as a flexible hammer toe, meaning the joint can still be manually straightened. However, if left unaddressed, the soft tissues tighten, leading to a rigid hammer toe that cannot be straightened without intervention.
Conservative Management Strategies
Conservative management is highly effective for addressing flexible hammer toes and focuses on relieving pressure and restoring muscle balance. Modifying footwear is the most immediate and significant step in controlling symptoms and preventing progression. Shoes should feature a deep, wide toe box to accommodate the bent toe and allow at least a half-inch of space between the longest toe and the shoe’s end. Avoid high heels and narrow-tipped shoes, which force the toes into the harmful flexed position.
Specialized devices can also help manage the condition by reducing friction and providing mechanical support. Non-medicated pads, such as silicone toe sleeves or corn pads, are used to cushion the prominent joint, preventing corns and calluses from developing due to rubbing against the shoe. Taping or using soft toe wraps can gently hold the toe in a straighter position, which helps slow the progression toward a rigid deformity. Custom or over-the-counter orthotic devices may be placed in the shoe to support the arch and redistribute foot pressure, addressing underlying biomechanical issues like excessive pronation.
Targeted exercises are an important component of conservative care, as they strengthen the intrinsic foot muscles and maintain joint flexibility. The “towel scrunch” exercise involves placing a small towel on the floor and using the toes to gather it toward the heel, which works the flexor muscles. Similarly, the “marble pickup” exercise requires using the toes to pick up small objects like marbles, improving dexterity and strength.
When Medical Intervention Is Necessary
Conservative measures may no longer be sufficient if the hammer toe becomes rigid, if pain is constant, or if mobility is severely impaired. Persistent symptoms, such as chronic pain or non-healing ulcers from friction, indicate that professional medical intervention is required. A podiatrist or orthopedic specialist can accurately diagnose the severity of the deformity and determine the best course of action.
For acute inflammation and pain, a medical professional may recommend a steroid injection into the affected joint to reduce swelling. However, for a rigid hammer toe, where the joint is permanently fixed, surgery is typically the only way to achieve lasting correction. The two main surgical approaches are arthroplasty and arthrodesis, or joint fusion.
Arthroplasty involves removing a small section of the bone from the proximal interphalangeal joint, which allows the toe to straighten and remain flexible, and this procedure is often preferred for the fourth and fifth toes. Arthrodesis, or joint fusion, removes the joint surfaces and then permanently fuses the two toe bones together to create a rigid, straight toe. Fusion is generally reserved for the second and third toes, which require more stability for walking, and often involves using pins or screws to hold the bones in place while they heal.
Preventing Recurrence and Further Progression
Long-term foot care habits are necessary to maintain the results of any treatment and prevent the condition from worsening or recurring. Consistent attention to shoe selection remains the most effective preventative measure. A practical tip for shoe shopping is to buy footwear later in the day, as feet naturally swell slightly, ensuring the chosen size accommodates the feet when they are at their largest.
Beyond size, focus on shoes made of soft, flexible materials with a wide, rounded toe box to minimize pressure points. Routine foot checks are also important, particularly for individuals with diabetes, as they are more prone to developing ulcers from unaddressed corns or calluses. Daily moisturizing can help keep the skin supple and prevent the buildup of hard skin over pressure areas.
Addressing the root cause of mechanical imbalance is also a significant long-term strategy. Custom-made orthotics can be used to correct underlying issues like collapsed arches or abnormal gait, which contribute to the muscle imbalance that causes the deformity.