Hammer Toe

A hammer toe is a common foot deformity where one or more smaller toes curl at the middle joint, making the toe resemble a hammer or an upside-down "V." This condition can affect any of the second, third or fourth toes. Hammer toes can become painful in advanced stages because they tend to become stiff and hard to move. Hammer toes can be classified into two types: flexible and rigid. Flexible hammer toes are less severe and can be corrected if treated early. In contrast, rigid hammer toes are more advanced and may require surgery since the joints have become immobile and misaligned.

What Are Hammer Toe Symptoms?

The following are some of the symptoms of hammer toe:

• Abnormal bending of a toe joint
• Pain or discomfort in the bent toe’s top part
• Calluses and corns develop from increased friction between the bent toe and shoe
• Toe joint stiffness that can become more painful and hard to move

What Causes Hammer Toe? 

A hammer toe typically results from an imbalance in its muscle and tendon, causing increased pressure on the toe tendons and joints, leading to its characteristic bending. Hammer toe causes include:

• Improper Footwear: Shoes that are too tight, narrow or have high heels can force toes into a bent position.
• Muscle Imbalance: Toe muscles usually work together to move the toe smoothly. However, if a toe stays bent for too long, the muscles and joints can tighten and cannot stretch back out easily. This imbalance puts pressure on the toe, causing it to bend into a hammer-like shape.
• Genetics: Some hammer toe cases are inherited.
• Arthritis: This can disrupt the balance around the toe, putting patients with arthritis at an increased risk of developing hammer toes.
• Trauma: Previous injuries to the toe can lead to the development of a hammer toe.

How To Fix Hammer Toe? 

Treatment for hammer toes varies depending on the severity and flexibility of the affected person’s toe joint. Non-surgical treatments may be recommended when the hammer toe deformity remains flexible, and pain and rigidity are manageable. Management strategies include:

• Changing Footwear: Opt for shoes with a roomy toe box, soft uppers and heels that are no higher than two inches. This can alleviate pressure on the toes and provide room for them to lie flat.
• Orthotic Devices: Custom shoe inserts may help control the muscle/tendon imbalance.
• Exercises: Toe-stretching exercises, such as towel curls or using your toes to pick up objects, can strengthen the muscles and alleviate symptoms.
• Protective Padding and Taping Non-medicated pads can help relieve pressure and pain caused by hammertoes.
• Medications: Anti-inflammatory drugs can reduce pain and inflammation around the affected toe.
• Injection Therapy: Corticosteroid injections may ease severe pain and inflammation.
• Splinting/Strapping: Temporary splints or straps may correct the toe position gently over time.

These conservative treatments are beneficial in the early stages of hammer toes and can prevent the condition from worsening. However, if the toe becomes rigid, causing significant pain and affecting mobility, or there are open sores or severe deformities, your doctor may recommend surgical options to help realign the toe and restore foot function.

What Is Hammer Toe Surgery? 

Hammer toe surgery is a procedure that aims to correct a hammer toe deformity, where a toe is permanently bent, causing pain and discomfort. This type of surgery is typically considered when non-surgical treatments have failed to relieve symptoms or when there is a severe hammer toe that has become rigid, making it immobile and misaligned. Hammer toe repair surgery aims to realign the toe, restore function and alleviate pain. The type of surgical technique to be used depends on the severity of the condition.

Hammer toe surgery is typically performed as an outpatient procedure under local anesthesia, possibly combined with sedation. Before the surgery, the patient’s foot is cleaned and sterilized. A local anesthetic is administered to numb the foot. The patient may also receive sedation to help relax during the procedure. The following are several different surgical techniques that may be used:

• Tendon Lengthening or Transfer: Tendon lengthening involves adjusting the muscle or its tendon to increase flexibility. In contrast, tendon transfer involves moving a tendon to a new position to help straighten the toe and restore its function.
• Joint Resection: In this procedure, the surgeon removes a portion of the bone from the deformed joint, which allows the toe to be straightened. The incision is typically made on the top of the toe at the joint. After the bone ends are trimmed, the toe is straightened. The joint may be stabilized with a pin or stitch that holds the toe straight while it heals.
• Fusion (Arthrodesis): Used primarily for rigid hammer toes, this technique involves removing the cartilage from the joint and then using pins, screws or a plate to fuse the joint in a straight position permanently. This eliminates the joint's flexibility but provides a permanent correction to the alignment.

Once the procedure is completed, the surgical site is closed with stitches and a sterile dressing is applied. In cases where pins are used, these might protrude from the toe and are typically removed a few weeks after surgery. After the surgery, patients need to wear special protective footwear during the healing process and avoid putting excessive pressure on the toe. Follow your doctor’s instructions on elevation, ice application and pain management to help reduce swelling and discomfort. You will also have follow-up appointments to monitor healing and eventually remove any non-dissolvable stitches or hardware.

How Long Does Hammer Toe Surgery Take? 

Recovery from hammer toe surgery varies depending on the procedure and the patient's overall health. Initially, patients may experience some pain, swelling and stiffness in the treated toe(s), which can be managed with pain relief medication prescribed by the surgeon. Here are typical post-operative steps: