Hammertoe is a type of foot deformity that results in the bending of the second, third, fourth or little toe. A network of soft tissue (ligaments, muscles and tendons) holds the toes straight in a normal, healthy foot. Trauma or external factors such as choosing poor-fitting or tight shoes may cause hammertoe or mallet toe. When there is an imbalance in the muscles and tendons in your toe, over time this may cause the toe to bend abnormally.

The condition is evident by a visible bend in the middle joint of the toe. Hammertoe may be painful and cause discomfort when moving the toe. Other painful problems such as corns and calluses may result from the toe rubbing your other toes or the inside of your shoe.

Shoe inserts or a change in footwear might help alleviate the symptoms. In more serious or advanced cases of hammertoe, surgery may be an option.

Your foot and ankle doctor will evaluate the problem and will also look at the shoes that you commonly wear. High heels or especially tight shoes may begin hammertoe or cause it to worsen. Stubbing or jamming your toe could also cause hammertoe or cause an existing condition to worsen. Women and older patients are at a greater risk for hammertoe. If your second toe is longer than your big toe, this may also put you at an increased risk.

Your physician will likely prescribe a change in footwear to allow more spacing, in addition to custom orthotic devices that a specialist will design for your foot. Corticosteroid injections may also help symptoms along with a regimen of anti-inflammatory medication.

If your hammertoe has become more rigid, surgery may be necessary to correct the condition.

Allowing adequate room in the toe box if your shoe is an important step to avoiding or correcting hammertoe. Also avoid heels or pointy-toed shoes. Go to a footwear specialist at the end of the day for a proper fitting, as your feet tend to swell throughout the day.

Do you feel or have any of these symptoms?

• Swelling or redness
• Pain in toe when walking or difficulty walking
• Unusual curvature of toe
• Inability to straighten the toe
• A corn or callus on the top of the middle joint of the toe or on the tip of the toe

What is Hammertoe and Mallet toe

Hammertoe and mallet toe are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight. The type of shoes you wear, foot structure, trauma and certain disease processes can contribute to the development of these deformities.

A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in your second, third and fourth toes.

Risk Factors that can increase your risk of hammertoe and mallet toe include:

• Age –The risk of hammertoe and mallet toe increases with age.
• Sex –Women are much more likely to develop hammertoe or mallet toe than are men.
• Toe length –If your second toe is longer than your big toe, it’s at higher risk of hammertoe or mallet toe.
• Certain diseases –Arthritis and diabetes might make you more prone to developing foot deformities. Heredity might also play a role

Hammertoe and mallet toe have also been linked to:

• Past trauma. An injury in which you stub, jam or break a toe can make it more likely for that digit to develop hammertoe or mallet toe.
• High-heeled shoes or footwear that’s too tight in the toe box can crowd your toes into a space in which they can’t lie flat.
• Abnormal balance of the toe muscles. The imbalance leads to instability, which can cause the toe to contract.

Before you see a physician  

In the early stages of hammer toe—when the joint is still flexible—treatment typically consists of simple measures. Some options to consider include

Potential at home nonsurgical treatments

Changes in footwear

Your doctor will recommend that you avoid wearing tight, narrow, high-heeled shoes. Shoes should be one-half inch longer than your longest toe—which, for many people is the second toe—and have a soft, roomy toe box.

You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. A shoe repair shop may be able to stretch a toe box so that it bulges out around the toe. Wearing sandals may help, if they do not pinch or rub other areas of the foot.

Exercises

Specific exercises can help stretch and strengthen the muscles in your foot. Your doctor may recommend gently stretching your toes manually or using your toes to pick things up off the floor. He or she may also recommend doing “towel curls” to strengthen the toes. To perform a towel curl, place a towel flat under your foot and use your toes to crumple it.

For example, doing “towel curls” can strengthen the toes and restore muscle balance

Over-the-counter remedies

Using commercially available straps, cushions or nonmedicated corn pads can help relieve pain. If you have diabetes, poor circulation, or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.

Reasons to see a physician and treatment options

• There is continuous pain in the toes
• Walking has become hindered or limited
• If the toe joint is rigid and no longer moveable.
• Have diabetes and see an open sore or wound forming on your toe.
• Notice signs of infection around your toenail.
• Suspect your bent toe could come from a fracture or soft tissue injury.

It is also important to note that even after consulting a physician most hammertoe and mallet toe deformities can be treated non-operatively.

However, if it cannot be treated non-operatively sometimes a foot and ankle orthopedic surgeon can recommend surgery. Surgery is typically performed on an outpatient basis using a local anesthetic. The actual procedure will depend on the type and extent of the deformity.

Surgical Options include:

• Tendon lengthening.For patients with a flexible toe joint, the condition can often be treated by lengthening the tendons that are causing the joint imbalance.
• Tendon transfer.Some patients with a flexible toe joint may benefit from treatment that involves transferring tendons from the bottom of the toe to the top of the toe to help pull the joint into a straight position.
• Arthrodesis (joint fusion).Patients who have a rigid toe joint may undergo tendon lengthening in combination with arthrodesis. In this procedure, your doctor will remove a small part of a bone in the toe joint to ensure that the toe can extend fully. He or she will then insert an external wire or pin and/or internal plate to hold the bones in place while the bones fuse together.

1. A) A hammertoe. B) In arthrodesis, a small amount of bone is first removed from the PIP joint. C)Here, a metal pin has been inserted to hold the bones in place until they fuse.

Prevention methods and other tips

You can avoid many foot, heel and ankle problems with shoes that fit properly. Here’s what to look for when buying shoes:

• Adequate toe room – Avoid shoes with pointed toes.
• Low heels – Avoiding high heels will help you avoid back problems.
• Adjustability – Laced or strapped shoes are roomier and adjustable.

These additional tips can help you buy the right shoes:

• Buy shoes at the end of the day. Your feet swell throughout the day.
• Check your size. As you age, your shoe size might change — especially the width. Measure both feet and buy for the larger foot.
• Buy shoes that fit. Be sure shoes are comfortable before you buy them. If necessary, a shoe repair store might be able to stretch shoes in tight spots, but it’s better to buy them to fit.

Anatomy

The forefoot is made up of five toes. Each toe has three joints—except for the first (big) toe, which usually has only two joints.

In hammer toe, the affected toe is bent at the middle joint, which is called the proximal interphalangeal (PIP) joint.

Hammertoe:

In mallet toe involves two body parts called the distal interphalangeal joint (DIPJ) and the flexor digitorum longus (FDL). The DIPJ is the last joint in the toe, closest to the toenail. The FDL is a muscle that starts near the shin and runs down to the four smaller toes. It helps the toes curl. When the muscle becomes too tight, it can bend a toe joint upward

Mallet toe:

Recovery and return to activity

After surgery, you may experience some stiffness, swelling and redness in your toe for up to 4-6 weeks. Although you will be able to put pressure on the foot immediately after surgery, you should try to limit your activity while the toe heals. Elevating your foot as much as possible will help speed up healing and reduce pain. Once healed, your toe may be slightly longer or shorter than it was before.