Hammertoe

The smallest four toes of each foot have three bony segments connected by two joints. Hammertoe is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments. The tip of the toe turns downward, making it look like a hammer or claw. The second toe is the one most often affected.

Hammertoe may be more likely to occur when the second toe is longer than the first toe or when the arch of the foot is flat.

Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don't fit well can crowd the toes, putting pressure on the middle toes and causing them to curl downward. Other causes include:

• genes. Some people are born with hammertoe
• bunions. These knobby bumps sometimes develop at the side of the big toe. This can make the big toe bend toward the other toes. The big toe can then overlap and crowd the smaller toes.
• arthritis. Arthritis in a toe joint can lead to hammertoe.

If the toes remain in the hammertoe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when shoes are not being worn.

Symptoms

The symptoms of hammertoe include:

• a curling toe
• pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward
• thickening of the skin above or below the affected toe with the formation of corns or calluses
• difficulty finding shoes that fit well

In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.

Diagnosis

Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe.

If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Prevention

Hammertoe can usually be prevented by wearing shoes that fit properly and give the toes plenty of room.

• Don't wear shoes with pointed or narrow toes.
• Don't wear shoes that are too tight or short.
• Don't wear high-heeled shoes, which can force the toes forward.
• Choose shoes with wide or boxy toes.
• Choose shoes that are a half-inch longer than your longest toe.
• If shoes hurt, don't wear them.

Treatment

Treating hammertoe involves straightening the toe, making tendons in the toes flexible again, and preventing the problem from returning. Some simple treatments include:

• Soaking your feet every day in warm water, then stretching your toes and ankles by pointing your toes.
• Using over-the-counter pads, cushions or straps to decrease discomfort.
• Splinting the toe to keep it straight and to stretch the tendons of the foot
• Exercising the toes to relax the foot tendons (a session with a physical therapist may help you get started with foot exercises). One simple exercise is to place a small towel on the floor and then pick it up using only your toes. You also can grasp at carpet with your toes or curl your toes up and down repeatedly.
• Wearing shoes that fit properly and give toes plenty of room to stretch out

In advanced cases in which the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat.

Surgery for hammertoe usually is classified as a cosmetic procedure. Cosmetic foot surgeries sometimes cause complications such as pain or numbness, so it's better to treat the problem with a shoe that fits properly.