Usually stemming from muscle imbalance, this condition occurs when the toe is bent into a claw-like position, affecting most frequently the second toe, often accompanying a bunion which slants the big toe toward and under it. Painful corns or calluses can develope on the top or bottom of the toe from the abnormal friction from a shoe or sock.
What Is Hammertoe?
Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.
Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn.
Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
Common symptoms of hammertoes include:
- Pain or irritation of the affected toe when wearing shoes.
- Corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
- Inflammation, redness, or a burning sensation.
- Contracture of the toe.
- In more severe cases of hammertoe, open sores may form.
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.
Hammertoes are progressive – they don’t go away by themselves and usually they will get worse over time. However, not all cases are alike – some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
- Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.
- Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels – conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
- Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.
- Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
- Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.
Types of surgery
Hammer toe surgery can be highly effective in people for whom the primary or only issue is hammer toe.
But when an underlying condition such as rheumatoid arthritis causes a hammer toe, doctors may recommend treating that condition first.
Surgical options for hammer toe include:
A tendon transfer pulls the toe into the correct position and often works well for a flexible hammer toe. Tendons attach muscle to bone. During a tendon transfer, the surgeon pulls a tendon near the hammer toe across the top of the joint. This pulls the toe into a straighter position, compensating for muscle weaknesses and improving the toe’s appearance. It should also reduce pain.
Joint resection can help with a fixed hammer toe. For this surgery, a doctor cuts ligaments and tendons to help straighten the toe and may also remove a portion of the bone. To keep the toe in place, the surgeon may insert temporary pins. These pins can be removed a few weeks after the surgery.
A fusion procedure can reduce the severity of a fixed hammer toe. In this procedure, the surgeon removes portions of the joint to allow bones to grow together. This straightens the toe and can help reduce pain.
A surgeon will cut tendons and ligaments, as well as the ends of the bones. Then, the surgeon will use pins to help keep the joint in place. The pins remain in place to allow the bones to grow together and are removed after the joint has fused.
When Is Surgery Needed?
In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed.
Often patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
A recurrence of Haglund’s deformity may be prevented by:
- Wearing appropriate shoes; avoid shoes with a rigid heel back
- Using arch supports or orthotic devices
- Performing stretching exercises to prevent the Achilles tendon from tightening