Definition

A hammertoe is marked by a contracture of the tendons, laxity of the ligaments, and angulation of the second and third phalanges of the toe.

Description

Hammertoes, one of the most painful foot ailments, can be traced directly to the wearing of narrow, pointed-toe shoes. Women most often are the victims of hammertoes. Most of the time, female footwear is not much wider at the front than at the heel, and the outline of the normal foot is rounded. The combination of narrow shoe and wide foot, of pointed shoe and rounded foot, causes, predictably enough, painful foot problems such as hammertoes.

Shoes sometimes compress the feet and constrict the muscles that move the toes. Subsequently, the muscles waste away, and the motions of the toe become puny and weak. At the same time, the toe is deprived of the room it needs to function effectively.

In an ill-fitting shoe, the toe seeks room anywhere it can be found. The pressure on the sides of the toes, as they are squeezed together by narrow footwear, causes a toe to "hammer." It curls up and arches until the toenail is nearly vertical.

As the pressure continues, the affected toe - the second or third, or sometimes both - might rise, contract, and overlap other toes. It is not uncommon for a hammertoe to move up and out of the line of toes and become an extracurricular digit that serves no purpose. It just lays in its pathological state on top of one or more of the other four toes, practically having become a vestigial appendage.

The tip of a hammertoe can strike the ground with a thud at every step and become flat and squat. A hard corn can form on top, and a distal corn can form at the hammering portion. The nail might split or grow inward. A corn or callused nail groove might develop where the flesh is caught between the nail and the toe bone or where the toe is angulated. A soft corn can prove especially annoying when it is between the hammertoe and the adjacent toe that is overlapped.

Although any toe may be affected, the second toe suffers most often. It is longer than the other toes and therefore more likely to be deformed by small footgear. The effects of a hammertoe are not limited to the toe. The toe bones, forced back against the metatarsals, exert pressure against the center of the foot. The ball of the foot suffers, calluses form, and muscular cramps develop.

Causes

Wearing tight-fitting stockings, short footgear, tapered-toe shoes, pointed-toe shoes, tight leotards, or really snug pantyhose for long periods of time can produce a hammertoe. Because these articles of apparel are necessarily worn on each foot, there can be two hammertoes, one on each foot.

Although some people are born with a hereditary contracture, and some acquire a contracture from having a systemic disease such as arthritis, the only thing that increases any hammering tendency from familial or hereditary traits is abuse of the feet from ill-fitting or ill-shaped footwear. Hammering will not occur unless abusive shoes are worn.

Treatment

Surgery is sometimes required for this condition. The surgeon, employing minimal-incision techniques uses a power-driven tool to file away a small wedge of bone from the angle of the contracture. This is a painless procedure done under a local anesthetic and the patient is able to walk home. A few days of recuperation is, however, necessary. The toe is held in its corrected position by a small splint until fusion of the bone takes place, usually within a few weeks.

In an alternative minimal-incision procedure, a surgeon can lengthen the tendon. Eliminating the contracture of the tendons on the top of the foot strengthens the movement of the hammertoe so it can uncurl and straighten.

Self Care

Self-care of a hammertoe involves exercise and mechanical stretching.

The wearing of rubber splints can also be tried. This involves attaching a small spoon-shaped splint to the hammertoe with a rubber band. The splint is worn during the day and a toe-stretching device is worn at night. Temporary relief can be achieved by lightly taping the protruding toe to hold it down, straight and even with the other toes. Tape is then used to create a sling for pulling the offending digit back into a normal alignment.

Questions to Ask Your Doctor

Is the hammertoe caused by badly fitting shoes?

Can it be helped by exercises and mechanical stretching?

Would a splint help?

Is surgical correction indicated?

How will this be performed?

What type of footwear do you recommend to provide relief?

 

PLEASE NOTE:
The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

SOURCES:
Sources used for updating the GEX ™ Health Library articles include a combination of peer-reviewed journals in medicine, public health, pharmacology, environmental health, nursing and other disciplines,along with reports from federal health agencies (CDC,NIH,AHRQ,etc.), foundations, and well-respected voluntary non-profit health organizations.

All articles are reviewed for accuracy by consulting M.D.s or appropriate content area experts. Prior to final publication, our Chief Medical Officer reviews, edits and approves each article. All articles are reviewed and updated no less than once in a twelve month period or more frequently where new information or research becomes available.

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