Arlington Foot & Ankle Center

Ben Pearl, D.P.M., F.A.C.F.A.S.

N.I.H. Consultant

HAMMERTOES

What causes hammer toes?
The most common toe deformities are hammer toes, and bone spurs.  These involve the lesser toes (2nd through 5th toes).  In a hammer toe the toe is bent at the middle knuckle of the toe,  A bone spur can occur anywhere on the toes but most commonly affects the 4th and 5th toes.  Each of the deformities can create corns on the toes and in severe cases redness, swelling, and even an open sore.  The corns develop because the skin is being crushed and irritated between the bones in your toes and your shoe.

People with flat feet, high-arched feet, or really flexible feet are more prone to develop these problems. Other causes are excessively long toes, muscle imbalance, injury, rheumatoid arthritis, and neurovascular disease. Over time, the mechanics of your foot and shoe’s that you wear increases the deformities. Woman are more frequently affected, probably because of the types of shoes they wear and use of tight stockings.

What are the symptoms?

Pain and corns usually develop over the toes due to the friction of the shoe in that area. This rubbing of the shoe may cause a red, inflamed sac of tissue called bursitis. Initially, the deformities are flexible and can bet treated with simple measures but, if left untreated, they can become rigid or stiff and cannot be straightened.  As time goes on, pain may develop deep in the toe joints and even the ball of the foot, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes and tight stockings will exacerbate these symptoms.

Hammer toes are sometimes caused or made worse by a Bunion deformity involving the big toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe.

What are the treatment options?
When hammer toes are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe to allow room for the toes to move. This includes lower heels, softer leather, wider toe boxes, and tennis type shoe. Use of a pumice stone to thin any corns and callouses is sometimes helpful.  Cushions (such as toe straightener’s) and various soft pads may provide relief from shoe pressure over the toes. We recommend that you never use a "medicated" corn pad since these contain a strong acid which does not know the difference between the bad and good skin and can lead to a chemical burn or deep open sore which can become infected.

When the hammer toes and claw toes are painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of deformity  that develops, and the more complicated the surgery becomes. Patients who have their symptomatic hammer toes and claw toes corrected earlier tend to have greater satisfaction after the procedure.

What does surgery involve?
The goal of surgical correction is to restore normal alignment and function of the toe joint.  If the toes are still flexible the tight tendons can be released and the toe straightened through a small poke-hole in the skin.  If the toe is rigid, the knuckle is straightened  and returned to a normal alignment. A small pin is sometimes placed inside the bones to hold the toe in proper position while it heals.  The pin does not stick out the end of the toe and very rarely needs to be removed.   If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint.  If a bone spur is the cause of the problem this is filed down through a small poke-hole in the skin.

Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.

When these treatment options are no longer providing the comfort you need, consultation with your podiatric physician is advised to discuss surgical options.

Copyright 2001, Dr. Pearl. All rights reserved.