What can be done for hammer toes?

Hammer toes are a common deformity of the toes that occurs when the middle joint of a toe becomes bent downward, looking like the shape of a ‘hammer’. This condition most common affects the second toe and can range from mild to severe, causing discomfort and difficulty in walking. A normal toe has three segments: the proximal phalanx (closest to the foot), the middle phalanx, and the distal phalanx (tip of the toe). In a hammer toe, the middle segment (at the proximal interphalangeal joint) becomes abnormally flexed downward, creating a curled or "hammered" appearance. Hammer toes often result from an imbalance in the muscles, tendons, or ligaments that hold the toe straight. Wearing tight, narrow, or high-heeled shoes that cramp the toes can force them into a bent position over time. Weakness in the toe muscles can cause the tendons to pull the toe into a bent position, which may become fixed if untreated. Conditions like rheumatoid arthritis or osteoarthritis can lead to joint deformities, including hammer toes. Trauma or repeated stress to a toe can lead to abnormal positioning and hammer toe deformity. Individuals with flat feet, high arches, or a predisposition to bunions may be more prone to hammer toes. Conditions like stroke, Charcot-Marie-Tooth disease, or diabetes (with neuropathy) can increase the risk of hammer toes by affecting nerve function and muscle control.

The toe appears bent at the middle joint, and the tip of the toe may press into the ground. Pain may occur when wearing shoes or walking due to pressure on the affected toe. Corns and calluses often develop on the top of the bent toe or at the tip due to rubbing against footwear. Inflammation may develop at the joint due to friction or irritation. Severe cases can affect balance and mobility. A hammer toe can be rigid or flexible. With the flexible hammer toe, he toe can still move at the joint and may return to a normal position when pressure is relieved. This stage is more easily treated with non-surgical methods. For a rigid hammer toe, the joint becomes stiff, and the toe cannot be straightened without surgical intervention. This is more common in severe or long-standing cases. Hammer toes are typically diagnosed through a physical examination where a doctor examines the toe’s flexibility, alignment, and any associated corns or calluses. X-rays may be used to assess the severity of the deformity and check for underlying bone or joint issues.

Treatment for hammer toes depends on the severity of the condition and the underlying cause. First, get proper footwear. Wear shoes with a wide toe box, low heels, and good arch support to relieve pressure on the toes. Use toe cushions, corn pads, or custom orthotic inserts to reduce friction and pressure. Stretching and strengthening exercises can improve muscle balance and flexibility. Examples include picking up small objects with the toes and manually stretching the affected toe. Splints or tape can help hold the toe in a straighter position and reduce discomfort. Surgical options can be used for severe or rigid cases. Tendons are adjusted to reduce tension and allow the toe to straighten. The bones of the affected joint are fused to hold the toe in a straight position permanently. Bone can be removed or reshaped to correct the deformity. In extreme cases, if the toe is severely damaged or infected, partial or complete removal may be necessary.

To prevent hammer toes, wear comfortable, properly fitting shoes with adequate space for the toes. Avoid high heels or narrow-toed footwear for extended periods. Perform regular foot and toe exercises to maintain strength and flexibility. Monitor for early signs of deformity, especially if you have predisposing conditions like arthritis or diabetes. With early intervention, flexible hammer toes can often be treated without surgery, and symptoms may improve significantly. For rigid hammer toes, surgical correction is generally effective in restoring toe alignment and relieving pain, although recovery may take several weeks. Long-term management often involves lifestyle adjustments, such as wearing appropriate footwear and performing preventive exercises.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.