Hammer toe deformities occur when the second, third or fourth toe is bent at the middle joint resembling a hammer. Pain typically occurs from pressure of the toe pushing up against a shoe, or under the ball of the foot due to increased pressure. If the joint at the tip of the toe is bent it is call a mallet toe. Mallet toes are similar to hammertoes with respect to pain on top of the foot, but rarely cause pain in the ball of the foot.
Hammer toes are most often caused by shoes that don’t fit properly, a muscle imbalance, or a combination. Shoes that are narrow at the ball of the foot push the smaller toes into a bent position. Subsequently the toes rub against the shoe, causing corns and calluses. Shoes with high heels force the toes against the shoe, increasing the pressure and the bend in the toe. If the toe is bent and held in one position long enough, the muscles the ligaments around the joint will stiffen.
Properly fitted shoes are important for treatment and prevention of hammertoes. Make sure you know your proper shoe size and purchase appropriate shoes to wear. Avoiding shoes with high heels and tight narrow toe box (ball of the foot) can prevent hammertoes from developing. If you already have stiff hammertoes, you may be able to relieve the pain of pressure by purchasing shoes with a deep wide toe box or, during warmer months, wear open toed sandals.
Other options may include exercises to stretch and strengthen the muscles. For example, you can gently stretch the toes manually and you can put a towel flat under your feet and use your toes to crumple it. Also you may try toe straps, cushions or digital pads (Silipos pads) to relieve pressure against the toes. If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.
When non-operative treatment fails surgery can correct hammertoe deformities. Surgical procedures for “fixed” deformity involve removing a small part of the toe bone to enable the toe to straighten. A pin or an implant is placed to maintain the straight position. If a pin is used it usually will be removed in approximately 4 weeks in the office. Surgical treatment of flexible hammertoes involved repositioning the tendon that bends to toe down. The tendon is released from the bottom of the tip of the toe and transferred to the top of the first toe bone (proximal phalanx), this procedure is called a flexor to extensor tendon transfer or Gridlestone-Taylor procedure. Both procedures are done outpatient with regional anesthesia. The foot will need to be protected with dressings and a post-operative shoe for 6-8 weeks.