A hammertoe is a deformity in which a toe is raised and bent, giving it the appearance of a claw. The condition most commonly develops in the second toe, but it may affect the others as well, causing the smaller toes to turn under and lie close to each other. A hard corn usually develops at the top of the raised joint. This bump of hardened tissue protects the bones from the constant irritation of a shoe, but it also causes intense pain if it presses upon an underlying nerve. The deformity may begin in childhood because of an inherited abnormality in the alignment of the foot’s metatarsal bones. When it develops in adulthood, the cause is usually poorly fitted footwear, especially high heeled shoes that force an uneven distribution of weight on the toes. Hammertoes may also be a consequence of the muscle and nerve deterioration that accompanies diabetes, stroke, and such neurologic disorders as Friedreich’s ataxia. Structural defects are occasionally responsible; these include a tight heel cord and weakness of the anterior tibial muscle, the calf muscle whose tendon extends across the top of the foot to the toes. In addition, hammertoe is some times associated with arthritis, corns and calluses, and obesity.
Other Causes of Deformed Toes
Foot injuries and congenital bone diseases may cause toe deformity, although in the latter case, other bones will be affected as well.
Diagnostic Studies And Procedures For Hammertoe
A hammertoe is readily apparent by visual examination, but the underlying cause may be more elusive. When visiting a podiatrist or a physician who specializes in foot disorders, take along an old pair of shoes so that the patterns of wear can be examined. These patterns provide clues to many foot problems, including a walking style that contributes to hammertoe. An important new diagnostic aid is the computerized gait analysis. A patient’s feet are connected with a computer. As the patient walks about the room, the computer provides a print out showing the weight bearing distribution on the foot during contact with the ground. The doctor then has a clearer picture of how the toes have been distorted by undue stress.
Medical Treatments
Drug Therapy
Lidocaine, a local anesthetic, sometimes provides long term relief when given by injection two or three times a week. If not, it may be combined with a cortisone injection.
Orthotics
If gait is a factor, a doctor may advise custom fitted orthotics. These are plastic and metal shoe inserts designed to relieve pressure on the toes. They can be designed from the computerized gait analysis or fashioned from plaster molds of the feet.
Surgical Treatment
If an operation is needed, it can usually be done in an outpatient setting under local anesthesia. Surgery consists of cutting the toe tendons, which releases the soft tissue and lets the curled toe relax. As ten dons heal, the severed ends reattach and lengthen, so that the toe straightens out. In severe cases, a small part of the metatarsal bone may be removed. Full recovery from surgery takes about a week, during which time a cane should be used. Soft shoes should be worn until the foot is fully healed. Individually fitted orthotics are essential for maintaining the correction.
Alternative Therapies
Alternative therapies may alleviate the symptoms and sometimes remedy an underlying cause, but they cannot correct the actual deformity.
Alexander Technique
This postural treatment can help when an abnormal gait and improper weight distribution are contributing to the problem.
Hydrotherapy
Soaking one’s feet in warm water for at least 20 minutes is the first step in softening a troublesome corn. The layers of dead skin can then be rubbed away with a pumice stone or fine emory board.
Massage
Foot massage using reflexology techniques may temporarily alleviate the pain of a hammertoe.
Self Treatment
To ease discomfort, cover the toe with mole skin or an unmedicated corn pad. Make sure your shoes have a toe box deep enough to comfortably accommodate your toes. Alternatively, wear opentoed sandals. Some people have had success with improvising their own orthotics by taking several shoe pads and cutting, shaping, and fitting them into their shoes.
To prevent the development of hammertoes, follow these guidelines:
- Get rid of shoes that don’t fit properly. Remember that feet get a bit larger with age, so you may not be able to wear shoes from several years ago.
- Buy new shoes late in the day, when your feet are likely to be somewhat larger than in the morning.
- Reserve high heels for occasions when you won’t be doing much walking. Avoid pointed toes, you should be able to wiggle your toes comfortably.
- Don’t buy shoes that feel too tight with the expectation that they will grow more comfortable with wear.
- Use every opportunity to walk bare footed. Second best is wearing thong sandals whenever possible.