Hammer Toes

‘Hammer toes’ refer to a condition of the foot whereby a toe becomes curled over in the middle joint of the digit, giving it an appearance that is similar to a hammer. The second, third and fourth toe of the foot are most often affected. This condition is often confused with ‘Mallet toe’, a similar condition that affects the upper joint of a digit.

Both conditions are most often caused by wearing high heels or constrictive, ill-fitting footwear that is too tight in the toe box. Even well structured heels can cause problems as the foot is crammed into the box of the shoe due to the steep angle of the foot. It is the toe being forced against the front of the shoe, causing an unnatural and often painful bend in the toe, that cause hammer toes to develop. This condition may also be inherited or may result from an injury to the foot, diabetic neuropathy, or the occurrence of arthritis or strokes.

Aside from the visible deformity additional symptoms usually include pain and reduced mobility in the toe as well as the development of corns and calluses on the top of the digit, which usually result from the protruding joint rubbing against the inside of the shoe. There is often chronic discomfort in the toe area, especially while walking or engaging in other weight bearing activities, and it may become difficult to properly fit shoes over the deformed joint.

If the pain becomes chronic and debilitating (affecting your ability to walk or carry out regular activities), or if the toes develop a clenched, claw-like appearance, then medical treatment should be sought. One of the difficulties in treating hammer toes is that the toes initially remain flexible but over time the tendons of the toe gradually tighten to the point where the toe effectively becomes ‘frozen’ in the hammer position, making treatment much more difficult.

Modification of footwear is one of the primary treatments of hammer toe, and foot orthotics are also often recommended to ensure proper placement of the feet and toes and to reduce pressure on painful or deformed areas. Shoes should not be restrictive; there should be an extra half an inch of space between the big toe and the box of the shoe. It will also likely be imperative that the feet and toes be stretched in order to restore mobility to hammer toes and strengthen misshaped muscles and tendons.

Conservative treatments take time but because they are non-invasive they are preferable to surgery in correcting this type of problem, however, severe cases of hammer toe, or stubborn cases that fail to respond to this type of care, may require surgical intervention. The type of surgery performed will depend on the nature and severity of the deformity, although most surgeries of this type do not require hospital stays. 

There will be painful swelling and stiffness after the surgery is performed and the toe may be longer or shorter than it appeared pre-surgery and activities will have to be reduced for the first several weeks or months post-op.

While surgery is an option for treating hammer toes it is often used as a last resort and conservative treatments, and early intervention, are the preferred methods of approach. 

 Suzy Pickhall, who has been a foot care expert over the past thirty years has written a viable guide on how to combat insoles, and a guide on orthotics.