Hammertoe

A hammertoe is a toe that bends downward at its middle joint, giving it a curled, hammer-like shape. It most often affects the second toe, though other toes can be involved. A hammertoe usually starts out flexible but can become stiff over time, and the bent joint often rubs against the inside of shoes.

• A toe bent at the middle joint that does not fully straighten
• Pain over the bent joint, especially in shoes
• Corns over the knuckle of the toe, or calluses on the toe tip or the ball of the foot
• Redness or swelling over the joint
• Difficulty walking or finding comfortable shoes

A hammertoe develops from an imbalance in the muscles and tendons that bend and straighten the toe. Over time the tendons tighten and hold the toe in a bent position.

Contributing factors include:

• Shoes that are too short, too narrow, or high-heeled, which crowd the toes into a bent position
• Gradual weakening of the small muscles of the foot
• Nerve conditions — a clinician may look for one when several toes are affected or feeling in the foot is reduced, as can happen with diabetes
• A tendency some people are born with

A hammertoe is diagnosed with an examination. The clinician checks whether the toe can still be straightened by hand (flexible) or is fixed in place (rigid), and looks for corns, calluses, and pressure points. X-rays may be taken to assess the joints. People with diabetes or reduced feeling in the feet may need further evaluation for nerve problems.

Non-surgical treatment is most helpful while the toe is still flexible:

• Shoes with a deep, roomy toe box and a low heel
• Pads or cushions over the joint to reduce rubbing
• Toe straps, splints, or straighteners
• Soft insoles
• Toe stretches and exercises, such as picking up a towel or marbles with the toes

Corns and calluses should be treated by a clinician rather than cut at home, especially if you have diabetes or poor circulation.

If the toe has become rigid, or pain continues despite these measures, surgery may be recommended. Depending on the deformity, the surgeon may release or lengthen a tight tendon, transfer a tendon to help straighten the toe, or remove a small piece of bone and fuse the joint straight, often held with a pin or implant while it heals.

Hammertoe surgery is usually an outpatient procedure. Most people can walk in a stiff-soled surgical shoe soon afterward, with instructions to limit activity and keep the foot raised. Swelling and stiffness in the toe can last for several weeks or longer. A fused toe no longer bends at that joint, and the toe may end up slightly shorter or longer than before.

• Wear shoes that are long and wide enough for your toes, with a low heel
• Re-measure children's feet regularly, because growing feet outgrow shoes quickly
• Address a flexible hammertoe early with footwear changes and exercises