Hammertoes are another forefoot deformity that can take a walker out of their activity. A Hammer toes
represent a tendon imbalance in the toes caused by one of the toe tendons getting an advantage over another toe tendon. Most commonly, it is one or all of the long Hammer toes
extensor tendons on the top of the foot that gets an advantage over one or all of the
flexor tendons on the bottom of the foot, to cause the first joint in the toe to be elevated above the ground. Most shoe wearing people chronically alter the delicate balance that co-exists amongst
the toe tendons whether they know it or not.
Certain risk factors increase your likelihood of developing a hammertoe. These include a family history of hammertoes, wearing tight or pointy-toed shoes, wearing shoes that are too small, having
calluses, bunions, or corns (thickened layers of skin caused by prolonged/repeated friction) Wearing shoes that are too small can force the joint of your toes into a dislocated position. This makes
it impossible for your muscles to stretch out. Over time, the practice of wearing improperly fitting shoes increases your risk of developing hammertoes, blisters, bunions, and corns.
The most obvious sign of hammertoes are bent toes, other symptoms may include pain and stiffness during movement of the toe. Painful corns on the tops of the toe or toes from rubbing against the top
of the shoe's toe box. Painful calluses on the bottoms of the toe or toes. Pain on the bottom of the ball of the foot. Redness and swelling at the joints.
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination,
the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the
degree of the deformities and assess any changes that may have occurred.
Non Surgical Treatment
Hammertoes that are not painful (asymptomatic) and still flexible may not require treatment. In mild cases, open-toed, low-heeled, or wider shoes and foam or moleskin pads can provide symptomatic
relief by reducing pressure. Taping (strapping) the affected toe can help to reduce deformity and pain. Physical therapy to instruct patients in exercises that passively stretch tight structures and
strengthen weak foot intrinsic muscles is also helpful with mild cases. Periodic trimming (debridement) of corns (clavi, helomata) by a podiatrist can provide temporary relief. Corticosteroid
injections are often very effective in reducing pain.
Probably the most frequent procedure performed is one called a Post or an Arthroplasty. In this case a small piece of bone is removed from the joint to straighten the toe. The toe is shortened
somewhat, but there is still motion within the toe post-operatively. In other cases, an Arthrodesis is performed. This involves fusing the abnormally-contracted joint. The Taylor procedure fuses only
the first joint in the toe, whereas the Lambrinudi procedure fuses both joints within the toe. Toes which have had these procedures are usually perfectly straight, but they take longer to heal and
don't bend afterwards. A Hibbs procedure is a transfer of the toe's long extensor tendon to the top of the metatarsal bone. The idea of this procedure is to remove the deforming cause of the
hammertoes (in this case, extensor substitution), but to preserve the tendon's function in dorsifexing the foot by reattaching it to the metatarsals. Fortunately, the Gotch (or Gotch and Kreuz)
procedure--the removal of the base of the toe where it attaches to the foot, is done less frequently than in years past. The problem with this procedure is that it doesn't address the problem at the
level of the deformity, and it causes the toe to become destabilized, often resulting in a toe that has contracted up and back onto the top of the foot. You can even have an Implant Arthroplasty
procedure, where a small, false joint is inserted into place. There are several other procedures, as well.
To prevent a hammertoe, never squeeze your toes into shoes that force them to bend unnaturally. Those tendons can tighten up, and leave a permanent, claw-like bend in your toe. Always slip your feet
into soft, roomy shoes that easily accommodate all of your toes. Stretching your toes can also help keep the tendons in the toes relaxed, and prevent a hammertoe. Use your hands to gently straighten
and stretch your toes or try to pick up objects with your toes, grabbing something from the floor, for example. Sitting on a blanket and using your toes to grab the ends with also relax your feet.