hammertoe is a condition which causes one or more of the smaller toes to become bent upwards. The toe can be straightened but if ignored may become a permanent deformity. Each of the 4 smaller toes consist of 3 bones called phalanges, forming two interphalangeal joints. The toe bends at the proximal or first interphalangeal joint. Initially it can be straightened, but if left untreated, this can become a permanent deformity.
If a foot is flat (pes planus, pronated), the flexor muscles on the bottom of the foot can overpower the others because a flatfoot is longer than a foot with a normal arch. When the foot flattens and lengthens, greater than normal tension is exerted on the flexor muscles in the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe. If a foot has a high arch (pes cavus, supinated), the extensor muscles on the top of the foot can overpower the muscles on the bottom of the foot because the high arch weakens the flexor muscles. This allows the extensor muscles to exert greater than normal tension on the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe.
The most obvious symptom of hammer, claw or mallet toe is the abnormal toe position. This is usually combined with pain: the abnormal foot position leads to excessive friction on the toe as it rubs against any footwear which can be extremely painful. Corns & Calluses: repeated friction can result in the formation of a foot corn or callus on top of the toes. Stiffness, the joints become increasingly stiff. In the early stages, the toes can usually be straightened out passively using your hands, but if allowed to progress, the stiffness may be permanent.
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
Non Surgical Treatment
Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.
A variety of anaesthetic techniques are possible. Be sure an discuss this with your surgeon during your pre-op assessment. The type of surgery performed will depend on the problem with your toes and may involve releasing or lengthening tendons, putting joints back into place, straightening a toe and changing the shape of a bone.Your surgeon may fix the toes in place with wires or tiny screws.
To help prevent hammer toes from developing, wear shoes or boots that provide sufficient width in the toe box to ensure minimal compression. Use inserts that help the toes flatten out and spread and give sufficient support to the metatarsal arch in the forefoot. If hammer toes have already formed, padded Hammer toes socks help protect the tops and the tips of the hammer toes and may reduce pain from rubbing and chafing.