Hammer toe is a deformity of the toe in which the middle joint is bent downward, resembling a hammer. This condition usually affects the second, third, or fourth toe and can lead to discomfort and difficulty with footwear.

Common Symptoms

• Visible Deformity: The toe appears bent at the middle joint.
• Pain: Pain in the affected toe, particularly when wearing shoes or walking.
• Corns and Calluses: Thickened skin on the top of the toe due to friction against footwear.
• Swelling and Redness: Inflammation around the affected joint.
• Restricted Movement: Difficulty moving the toe and reduced flexibility.

Cause & Anatomy

Causes and Risk Factors:

• Footwear: Wearing shoes that are too tight or have high heels, which can force the toe into a bent position.
• Muscle Imbalance: Imbalance between the muscles that flex and extend the toe, often due to conditions like arthritis or neurological disorders.
• Trauma: Injury to the toe can lead to hammer toe deformity.
• Genetics: A family history of foot deformities can increase the risk.
• Other Foot Problems: Conditions like bunions can push the toe out of alignment, leading to hammer toe.

Anatomy of the Toe:

• Phalanges: The bones of the toes.
• Metatarsophalangeal (MTP) Joint: The joint at the base of the toe.
• Proximal Interphalangeal (PIP) Joint: The joint in the middle of the toe.
• Distal Interphalangeal (DIP) Joint: The joint at the tip of the toe.
• Tendons and Ligaments: Connective tissues that stabilize and move the toe.

Diagnosis

• Evaluation of symptoms, footwear habits, and any history of foot problems.
• Physical examination to assess the degree of deformity, pain, and movement.
• X-rays: To evaluate the bone structure and severity of the deformity.

Prevention

• Proper Footwear: Wearing shoes that fit well and provide adequate room for the toes.
• Regular Foot Care: Monitoring for early signs of deformity and addressing them promptly.
• Foot Exercises: Regular toe stretches and strengthening exercises to maintain muscle balance.

Non-Surgical Treatment

Footwear Modifications:

• Wearing shoes with a wide toe box and low heels to reduce pressure on the toes.
• Avoiding tight or narrow shoes.

Orthotic Devices:

• Use of shoe inserts or pads to cushion the toe and prevent friction.
• Toe splints or straps to help straighten the toe.

Exercises:

• Toe stretches and strengthening exercises to improve flexibility and balance muscle function.

Medications:

• Over-the-counter pain relievers like acetaminophen or NSAIDs to reduce pain and inflammation.

Protective Padding:

• Use of padding or corn pads to reduce pressure and friction on the affected toe.

Surgical Treatments

Tendon Release:

• Cutting or lengthening the tendons to allow the toe to straighten.

Joint Resection:

• Removing a small section of bone to allow the toe to be straightened.

Fusion (Arthrodesis):

• Fusing the joint to keep the toe straight permanently.

Implant Surgery:

• Inserting a small implant to maintain toe alignment.

Rehabilitation

Postoperative Care:

• Pain management, wound care, and prevention of infection.
• Keeping weight off the foot initially, followed by gradual return to normal activities.

Physical Therapy:

• Exercises to restore strength, flexibility, and range of motion.
• Techniques to improve gait and reduce pain during movement.

Potential Complications:

• Recurrence: The deformity can recur if underlying causes are not addressed.
• Infection: Risk of infection at the surgical site.
• Stiffness: Reduced flexibility or movement in the toe post-surgery.
• Nerve Damage: Potential for nerve damage leading to numbness or tingling.

FAQ’s

Can hammer toe be corrected without surgery?
Yes, in mild cases, non-surgical treatments such as footwear modifications, orthotic devices, and exercises can help manage and correct the deformity.

How long does it take to recover from hammer toe surgery?
Recovery time varies depending on the type of surgery, but most patients can return to normal activities within 6-8 weeks. Full recovery may take several months.

Are there any risks associated with hammer toe surgery?
As with any surgery, there are risks including infection, nerve damage, stiffness, and recurrence of the deformity.

Can children develop hammer toe?
Yes, although it is more common in adults, children can develop hammer toe, often due to hereditary factors or wearing ill-fitting shoes.

Is hammer toe the same as mallet toe?
No, hammer toe affects the middle joint of the toe, while mallet toe affects the joint closest to the tip of the toe.