Hammer toe is a condition which causes one or more of the smaller toes to become bent upwards. The toe can be straightened but if ignored, it may become a permanent deformity. This toe injury is often caused by wearing shoes that are too small as they force the toes into a shortened position which makes them bend upwards. Correcting this injury early on is key to making a full recovery.
Each of the 4 smaller toes consists of 3 bones called phalanges, forming two interphalangeal joints. The toe bends at the proximal or first interphalangeal joint. Initially, it can be straightened, but if left untreated, this can become a permanent deformity.
People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.
Hammer toe is often caused by wearing shoes that do not fit properly. If shoes are too small either in length or width, then the toes are held in a shortened position for long periods and the muscles eventually shorten and pull the toes into the bent position.
Alternatively, it can be caused by over-activity in the extensor digitorum longus muscle and weakness in the counteracting muscle under the foot, such as flexor digitorum longus.
Flexor digitorum longus muscle causes the toes to grip and mold to the floor’s surface which is vital in maintaining balance on rough surfaces. The tendons pass under the foot. Walking barefoot on an uneven surface is an excellent exercise for this muscle and it can be stretched by pulling the foot and toes upwards.
Extensor digitorum longus muscle (often shortened to EDL) is found in the front of the lower leg, in the outer more muscle-bound compartment. When the muscle contracts the toe are pulled upwards. Toe raises are a good strengthening exercise for this muscle and it is stretched by pulling the toes and foot downwards as in a shin stretch.
Sometimes it can be a congenital condition, meaning it is present from birth. It is also more common in those with arthritis in the foot or diabetes.
In the earlier stages of hammer toe, when the toes can still be manually straightened, then conservative treatment is appropriate. This means wearing shoes which are a half size bigger than normal and which are not narrow around the toes. Exercises to stretch the toes out and strengthen the muscles under the foot which balances the tightness of the top tendons are important. Padding or corn plasters can be used to ease the discomfort of any associated corns and calluses.
If this fails or if treatment is not sought until the toes are permanently misaligned, then surgery may be required. Surgery may involve either cutting the tendon or fusing the joint. Congenital conditions should be treated in early childhood with manipulations and splinting.