Hammertoe is a condition in which the toes of your feet become contracted into an upside-down "V" shape, causing pain, pressure and, often, corns and calluses. Hammer toe
can develop on any of the toes, but generally affects the middle three toes,
most often the second toe. The bones, muscles, ligaments and tendons of your feet normally are well-balanced to distribute your body's weight while standing, walking and running. When the first and
second joints of your toes experience the prolonged stress that develops when the muscles that control them fail to work together properly, the pressure on the tendons that support them can lead to
the curling or contraction known as hammertoe.
Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe
is bent and held in one position long enough, the muscles tighten and cannot stretch out. Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes
into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes
the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.
Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin
problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most
common at the level of the affected joint due to continuous friction of the deformity against your shoes.
Hammer toes may be easily detected through observation. The malformation of the person's toes begin as mild distortions, yet may worsen over time - especially if the factors causing the hammer toes
are not eased or removed. If the condition is paid attention to early enough, the person's toes may not be permanently damaged and may be treated without having to receive surgical intervention. If
the person's toes remain untreated for too long, however the muscles within the toes might stiffen even more and will require invasive procedures to correct the deformity.
Non Surgical Treatment
Many people start by treating the problem themselves when they have a painful corn or callus. They try to remove the corn by cutting it off or by applying strong acids, and they try to cushion the
toe by applying cushioned pads. Because these treatments can be difficult to perform by oneself (and should never be done by oneself when the patient is diabetic or circulation is poor), and because
these treatments only treat the symptom, not the structural deformity that causes their symptom, these treatments can often provide only limited success, and often any success is for only short
periods of time. Changes in shoe choices and various types of paddings and other appliances may help, too. For longer-lasting help, we must examine the cause of the deformity. The reason for knowing
the cause is that the type of treatment will vary, depending upon the cause of the complaint. Orthotics help hammertoes
control the causes of
certain types of contracted toes, (those caused by flexor stabilization, for example), but not other types.
In more advanced cases of hammer toe, or when the accompanying pain cannot be relieved by conservative treatment, surgery may be required. Different types of surgical procedures are performed to
correct hammer toe, depending on the location and extent of the problem. Surgical treatment is generally effective for both flexible and fixed (rigid) forms of hammer toe. Recurrence following
surgery may develop in persons with flexible hammer toe, particularly if they resume wearing poorly-fitted shoes after the deformity is corrected.