The name Hammer toes
comes from the way the tip of
the toe hits or hammers on the floor with each step. The primary deformity seen in a hammer toe is found at the PIPJ (proximal interphalangeal joint) which is the first or more proximal of the two
joints of the toe. A mallet toe, on the other hand, is a similar deformity but is found in the DIPJ (distal interphalangeal joint). And lastly, claw toes are a deformity where the entire toe grabs
and involves the MPJ (metatarsal phalangeal joint) PIPJ and DIPJ. Collectively, these deformities are referred to as hammer toes. Hammer toes can affect one or all of the toes simultaneously.
It?s thought that hammertoe may develop from wearing shoes that are too narrow or too short. This probably explains why women are far more prone to the condition than men: almost 9 out of 10 women
wear shoes that are too small. Another cause is diabetes mellitus, which produces nerve damage in the feet that may lead to hammer toe.
The middle joint of the toe is bent. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to
move the toe. It will be painful. A corn often forms on the top of the toe. A callus is found on the sole of the foot. Walking or wearing shoes can be painful.
Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your
foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.
Non Surgical Treatment
In the early stages, the deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment is delayed too long, permanent stiffness can ensue which can only be corrected by
surgery. The most effective treatment options are good fitting footwear. Shoes with a wide toebox will be more comfortable and will reduce the tension on the muscles and friction on the toes. Avoid
high heels as they push your feet forwards to the front of Hammer toe
shoes. This increases the pressure on the toes, forcing them to bend more than usual. Shoes should ideally be half an inch longer than your longest toe. Exercises to strengthen and stretch the
muscles can be really helpful. Simple things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can work well.
Probably the most frequent procedure performed is one called a Post or an Arthroplasty. In this case a small piece of bone is removed from the joint to straighten the toe. The toe is shortened
somewhat, but there is still motion within the toe post-operatively. In other cases, an Arthrodesis is performed. This involves fusing the abnormally-contracted joint. The Taylor procedure fuses only
the first joint in the toe, whereas the Lambrinudi procedure fuses both joints within the toe. Toes which have had these procedures are usually perfectly straight, but they take longer to heal and
don't bend afterwards. A Hibbs procedure is a transfer of the toe's long extensor tendon to the top of the metatarsal bone. The idea of this procedure is to remove the deforming cause of the
hammertoes (in this case, extensor substitution), but to preserve the tendon's function in dorsifexing the foot by reattaching it to the metatarsals. Fortunately, the Gotch (or Gotch and Kreuz)
procedure--the removal of the base of the toe where it attaches to the foot, is done less frequently than in years past. The problem with this procedure is that it doesn't address the problem at the
level of the deformity, and it causes the toe to become destabilized, often resulting in a toe that has contracted up and back onto the top of the foot. You can even have an Implant Arthroplasty
procedure, where a small, false joint is inserted into place. There are several other procedures, as well.
To prevent a hammertoe, never squeeze your toes into shoes that force them to bend unnaturally. Those tendons can tighten up, and leave a permanent, claw-like bend in your toe. Always slip your feet
into soft, roomy shoes that easily accommodate all of your toes. Stretching your toes can also help keep the tendons in the toes relaxed, and prevent a hammertoe. Use your hands to gently straighten
and stretch your toes or try to pick up objects with your toes, grabbing something from the floor, for example. Sitting on a blanket and using your toes to grab the ends with also relax your feet.