What is hammertoe?
Hammertoe is the term to describe a contracture or bending of one or both proximal interphalangeal and distal interphalangeal joints of the toes, it does not affect the big toe. The abnormal contracture increases pressure on the toe when wearing certain shoes, causing pain and discomfort to develop.
The toes consist of 5 bones numbered in the sense that your big toe is 1st and your little toe is your 5th.The toes are called phalanges which like the fingers are individually divided into three parts, there is a distal section (the section under your nail), a middle section and a proximal section (the section that connects to the metatarsals). The first joint is known as the metatarsal-phalangeal joint (the joint that connects the metatarsals to the phalanges), the second joint that connects the proximal phalangeal bone to the middle phalangeal bone is called the proximal interphalangeal joint (pip joint) and the last joint is the distal interphalangeal joint (dip joint) connecting the distal and middle bones. The big toe differs from the rest by only having two interconnecting joints as it is missing the proximal interphalangeal joint, which is partly the reason why it is not affected by hammertoe.
Why and when does hammertoe happen?
Hammertoe is normally the result of poor foot biomechanics or posture like flat feet or high arches that develop over time. Altered function of the feet in these circumstances leads to an increased and uneven pressure through the toes. This leads to muscle and tendon imbalance that causes the toe to contract and bend.
Hammertoe can also be the result of a previous foot or toe injury and is often brought on by wearing unsupportive and tight shoes. It has also been known to run in the family due to an increased likelihood of inheriting a foot type or shape that is prone to developing the condition. For example if one toe is longer than the rest it will curl to fit into a shoe, this continual cramped position encourages the permanent contraction of the toe.
What does hammer toe feel like?
In the early stages hammertoe will present as a mild bending deformity of the toe. The toe will still be flexible but pain and discomfort will be experienced after wearing tight shoes. Gradually over time the deformity and rigidness of the toe will progress and so will the pain and discomfort levels. Corns and calluses will develop around the top and in-between the contracted toes and along the ball of the foot due to increased friction against shoes, open sores can occur in these places but only in severe cases. As well as pain and discomfort there will be varying levels of swelling around the toe often accompanied by a burning sensation and redness in the surrounding skin.
How is hammertoe diagnosed?
Your GP or podiatrist/chiropodist should be able to diagnose you by listening to your symptom history and thoroughly examining the foot and the contracture of the toes. Your doctor will most likely order an X-ray of the foot and toe to determine the extent of the contraction deformity.
What treatments are available for hammertoe?
The treatment options for hammertoe vary depending on how early the deformity is diagnosed. The earlier it is diagnosed, the easier it is to treat. Therefore, it is advisable that report to your doctor or podiatrist when you first notice symptoms. If you wait until the toe becomes rigid, the deformity will be more difficult to manage. In the early stages most doctors will recommend conservative treatment to prevent and delay the need for surgical intervention in the future. Conservative treatment will include shoe modifications, selecting shoes with a large toe compartment avoiding shoes with pointed toes and very high heels. Orthotic inserts may help to improve any poor foot posture or biomechanics. Certain pads can be used to shield the corns around the toe and straps or splints may be prescribed in an attempt to straighten and re-align the toe. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. There is also the option of corticosteroid injections to reduce persistent inflammation and pain. Your doctor may refer you to a podiatrist/chiropodist or physiotherapist who may use ultrasound or manual therapy to reduce pain levels.
The progressive nature of hammertoes varies from case to case. Non- surgical treatment options only delay the deformity and most cases will continue to worsen over time. Doctors will normally recommend surgical intervention for the more severe, progressed cases or when conservative treatment starts to fail. You will be referred to a specialist ankle and foot orthopaedic surgeon who will recommend the type of surgery based on your health, activity level and the severity and extent of your condition. The recovery and results you see after surgery will vary, depending on the type of procedure performed.