Causes, Symptoms, and Treatment of Hammertoes

People of all ages can have toe problems, from infants born with deformities, to older adults with acquired deformities. The major culprit of toe deformities in adults is tendon imbalance. The tendons may stretch or tighten to compensate for imbalance of the foot leading to deformity of the toe(s). Thus, people with abnormally long toes, flat feet or high arches have a greater tendency to develop toe deformities. Over time, the toe may become permanently deformed and arthritic changes may develop. The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, overlapping and underlapping toes, and curled toes. These deformities may lead to corns or calluses and inflammation of the small protective pouches over the deformed joints leading to pain and swelling. Pain may or may not be present.

Definition
Hammertoe is a condition in which the toe is bent in a claw-like position. It can be present in more than one toe but is most common in the second toe.

Description
Hammertoe is described as a deformity in which the toes bend downward with the toe joint usually enlarged. Over time, the joint enlarges and stiffens as it rubs against shoes. Other foot structures involved include the overlying skin and blood vessels and nerves connected to the involved toes.

Causes and symptoms
The shortening of tendons responsible for the control and movement of the affected toe or toes cause hammertoe. Top portions of the toes become callused from the friction produced against the inside of shoes. This common foot problem often results from improper fit of footwear. This is especially the case with high-heeled shoes placing pressure on the front part of the foot that compresses the smaller toes tightly together. The condition frequently stems from muscle imbalance, and usually leaves the affected individual with impaired balance.

Diagnosis
A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of hammertoe and other foot conditions. Because the condition involves bony deformity, x rays can help to confirm the diagnosis.

Treatment
1. Conservative: Wearing proper footwear and stockings with plenty of room in the toe region can provide treatment for hammertoe. Stretching exercises may be helpful in lengthening the excessively tight tendons.
2. Surgery: In advanced cases, where conservative treatment is unsuccessful, surgery may be recommended. The tendons that attach to the involved toes are located and an incision is made to free the connective tissue to the foot bones. Additional incisions are made so the toes no longer bend in a downward fashion. The middle joints of the affected toes are connected together permanently with surgical hardware such as pins and wire sutures. The incision is then closed with fine sutures. These sutures are removed approximately seven to ten days after surgery.
3. Alternative treatment: Various soft tissue and joint treatments offered by chiropractic and massage therapy may be useful to decrease the tightness of the affected structures.
4. Prognosis: If detected early, hammertoe can be treated non-surgically. If surgery becomes necessary, surgical risks are minimal with the overall outcome providing good results.
5. Prevention: Wearing comfortable shoes that fit well can prevent many foot ailments. Foot width may increase with age. Feet should always be measured before buying shoes. The upper part of the shoes should be made of a soft, flexible material to match the shape of the foot. Shoes made of leather can reduce the possibility of skin irritations. Soles should provide solid footing and not be slippery. Thick soles lessen pressure when walking on hard surfaces. Low-heeled shoes are more comfortable, safer, and less damaging than high-heeled shoes.