Patient Education

Crooked Toes (Hammertoes)

Description

Putting toes and hammers together often results in some major misfortune. So, as you might imagine, the condition called hammertoes isn’t really an ideal state for the digits of your feet. (Although really, it’s hard to say whether the name came about because the toes resemble hammers, or simply look as though they’ve been hammered.) When you have hammertoes, the joints of one or more toes become semi-permanently or permanently bent, making the middle joint of the toe jut up, just as if your toe had decided to take on the shape of a tent (or maybe a pyramid, if you’re into ancient history). Hammertoes often start out flexible, meaning you can still bend the joint-it just tends to revert to the crooked position when you leave it alone, although they do become inflexible over time. As the condition worsens, the joints become locked in place, which is not the way joints are supposed to behave.

Hammertoes may have several causes, but most commonly come about due to muscle imbalances. The tendons pulling the toe inward may be stronger than the ones that pull the toe straight, thus resulting in a toe that’s bumped up in the middle. Hammertoes (or a tendency to develop them) might have been something you inherited from your parents (or grandparents, or third cousins), although they may also be caused or exacerbated by wearing shoes that scrunch the toes up into a small space (i.e. shoes with tiny little toe boxes and/or high heels-the usual lineup of suspects). They may also develop due to an injury, such as a break in the toe, or arthritis.

Symptoms

Some people may not experience uncomfortable symptoms until their condition is a little more advanced. However, the first sign that something’s up is the visibly obvious bending of the toe upward at the middle toe joint, making the toe look like a hammer or a claw. This may be followed by pain or even corns on the top of that pointed toe joint (caused when your shoe rubs against the raised toe), and calluses on the ball of your foot (they form because the base of the toe is now jutting down abnormally and putting extra pressure on the ball of the foot).

As things get a bit more severe, the joint itself may begin to feel stiff and painful, and it may become inflamed (red, swollen, warm to the touch). Eventually, you may not be able to move the joint very well, or at all.

Diagnosis

It’s a good idea to go in to see your podiatrist when your toes begin to take on that hammer-like or clawed appearance, especially if you’re finding it painful to walk because of the condition. Your podiatrist will likely make the diagnosis by examining your foot visually, and may test the joint for flexibility and pain. He or she may also suggest X-rays in order to get an insider’s look at what’s going on in your foot.

Treatment

Treatment options are varied, and depend a great deal on how far progressed your hammertoes are. For instance, when the joint’s still pretty flexible, it may be possible to treat the condition entirely without surgery. This will likely be accomplished by your podiatrist prescribing orthotics (fancy shoe inserts designed specifically for you) that will help correct the imbalance in your foot that’s causing the hammertoes. Plus, they’ll make you more comfortable while they’re doing all that correcting. Your podiatrist may also try taping the toes (that is-he or she will put tape on the toes, not take the toes in for a session in a recording studio) in order to straighten them and provide additional support. Exercising your calves (the ones on your legs-not the ones on the farm) and toe muscles will also help provide additional strength and stability for your foot.

There are also a few things you can do to relieve some of the painful symptoms that come with hammertoes. You could try using pads to reduce the pressure on the tops of your toes: hammertoe pads or corn pads may be available over the counter, but you may want to avoid the medicated ones-the acid in the medication may be harmful, particularly to those with circulation problems. If your toe joint is swollen and inflamed, you can try applying ice (20 minutes on, 40 minutes off, and always use a thin towel between the ice and your skin) or taking anti-inflammatory medication (ibuprofen, or you can talk to your podiatrist about a cortisone shot) to reduce inflammation. Also, (and this may be an obvious one, but it’s a method some people ignore), you should probably ditch the shoes with the tight toes and high heels. Give your toes plenty of room in the toe box (about half an inch past the end of each toe) and avoid heels over two inches (and lower, if possible), since they tend to squish your toes into the end of your shoe.

If doing all that doesn’t really seem to help, or if your toes have gotten to the point where they refuse to bend at all (the stubborn little things), then it may be time to consider surgery. Your podiatrist knows a lot of options and can discuss which ones will be most likely to fit your particular needs. For the more flexible kinds of hammertoe, a simple release of the tight tendon may be all you need to get relief. This usually involves only a very small incision and a pretty rapid recovery time (although that recovery time gets longer if more toes receive the surgery). Or, your foot surgeon may find it best to remove a little portion of the bone from the joint in order to straighten it. This may also be paired with a tendon release. In cases where the condition is pretty advanced, it may be necessary to fuse the joint (which usually involves the insertion of pins into the joint to hold it in place while it heals), remove wedges of skin, or insert or rebalance the affected tendons.

Recovery time will vary, depending on what treatment method you use. But, if all goes well, you can once again have toes that resemble toes, and not something you find in a greasy toolbox.