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Hammertoes





Hammertoe illustration labeledA hammertoe is a crooked toe that is the result of tendon imbalance. Over time the tendons in the feet will gradual pull the toes up. The tendon imbalance is due to the combination of foot type and faulty foot mechanics. This means that the position and mechanics of the foot cause the foot to function in a way which results in unequal pull of the tendons on the toes. It may take decades for the hammertoes to develop.     

Small shoes can contribute to the development of hammertoes, but most likely the hammertoes are due to either a high or low arch foot. The pull of the tendons on the top of the foot will not equal the pull of the tendons on the bottom of the foot. This will cause the gradual rise of the toes. Shoes can rub the tops of the toes and cause irritation and corns. Hammertoes develop slowly over time, but pain may come on quickly and suddenly as a result of a corn or a blister.       

Severe hammertoe called a crossover toe as it lays over the great toeThe image to the left shows a severe hammertoe deformity. This hammertoe developed, in part, because of the bunion deformity. The big toe moved under the 2nd toe and pushed it up. The 2nd toe became unstable and eventually crossed over the big toe. This is called a cross over toe. Many people with severe hammertoes and crossover toes will have pain under the 2nd toe joint in addition to pain on top of the second toe.

Hammertoe visualized on X-ray and labeledOn the X-ray to the right, the hammertoe can be seen, with the contracture at the toe joint. Mouse over to see the hammertoe outlined.

 The image below shows the area of pain. The ball of the foot can be sore and develop calluses from the crooked toes pressing down. The diagram on the right illustrates the pressure the hammertoe can place on the ball of the foot.

2nd metatarsal overload as a result of a hammertoe

Hammertoe diagram showing retrograde force and ball of foot pain



The 5th Toe

The 5th toe is unique because when the toe hammers, it also rotates. This rotation creates pressure between the toes resulting in the development of a corn between the 4th and 5th toes. A corn can also develop on the outside of the 5th toe.

4th interspace corn on foot 4th interspace corn on foot with padding
The small bone (head of the proximal phalanx) of the 5th toe is pushed up against the base of the small bone  (proximal phalanx) of the 4th toe causing a corn to develop between the toes. This images shows the placement of an interdigital corn pad. The pads should have an aperature (donut hole) and the hole is place over the painful corn. Medicated pads should be avoided.



Treatments

There are not many treatment options for hammetoes. Many of the options revolve around keeping the foot comfortable. Changing to a wider pair of shoes, with more depth in the toe box is an important step. Shoes which are too tight and too narrow will cause rubbing and irritation. More on shoes. For individuals with overpronation which contributes to hammertoe development, a pair of orthotics may be recommended. More on the cause of common foot problems.

Hammertoes pads can help keep the pressure off the tops of the toes. The pad should have a hole that is placed over the corn or area of irritation. This helps to disperse the pressure from the shoe and relieve the pain. Don't use medicated corn pads on the hammertoes. The medication will not change the hammertoe and may only irritate the corn. 

Felt corn pad on hammertoe

Hammertoe Cushion placement on ball of foot

Hammertoe Cushion image

Hammertoe cushions can also be used on hammertoes. These pads are placed under the toes, with a strap that is placed over the toes. With standing and walking, these pads helps to straighten the toes (not permanently - just while walking).This will take pressure off the tops of the toes as well as limit pressure on the ball of the foot.

Pads and cushions can help to alleviate pain and irritation associated with hammertoes, but will not change the deformity.  

Surgery

When conservative care fails and there is considerable pain at the hammertoes, surgery is then recommended. Basic hammertoe surgery involves taking out the joint in the toe and then straightening the toe. Many times a pin is used to stabilize the toe. In many cases, the toe joint is fused. Although the surgery is fairly simple, straightforward and has a relatively short recovery time of 6 weeks, the toes can remain swollen for many months.

Hammertoe surgery with phalanx removed Hammertoe Surgery with pin placement

 

Picture of hammertoe surgery intraop Intraoperative picture of hammertoe surgery with pin placement X-ray of hammertoe surgery with pin placement

 

In some instances, a more advanced procedure must be done to address the cause of the hammertoes. This may involve tendon transfers or bone fusions. Discuss the options with your doctor.


More information on corns.


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last updated 6/12/12

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.