Each foot has twenty-six bones, fourteen of them in the toes. Toes are huge contributors in allowing us to move and balance. Toes are easily ignored until they hurt and get stuck in the bent position, known as hammer toe. This inability to straighten the toes is often the result of the lack of space in tight, pointy, or high-heeled shoes. Hammer toe can affect one or multiple toes, often the second, third and fourth toes. In its early stages the toes are still somewhat malleable, while in advanced cases the toes become completely immobile or rigid. Thickened skin known as corns and callouses often accompany hammer toe because the bent shape of the toe causes the shoe to rub on the top of the toe. Hammer toe is easily diagnosed through a visual-physical exam.
Hammer toe occurs when there is an imbalance in the connective tissue or muscles, tendons, and ligaments around the toe joint. This imbalance causes the middle joint of the second, third, or fourth toes to get stuck in a bent shape. In flexible hammer toe, the earlier, milder form of the condition, the toe or toes can still move at the affected joint. The condition progresses to rigid hammer toe when the stiff connective tissue presses the joint out of alignment over a long period to the point of immobility. Both versions are treatable, although surgery is sometimes required to regain mobility in rigid hammer toe.
People with hammer toe commonly experience pain at the top of the afflicted toe when putting on a shoe, pain in that joint when walking or moving the toe, and pain at the base of the afflicted toe on the underside of the ball of the foot. Corns or calluses can form on top of the joint and the area may become red or discolored. In severe cases, hammer toe causes difficulties in walking and an inability to flex or wiggle the toes.
There are multiple types of toe malformation. In hammer toe the first joint (metatarsophalangeal joint) is cocked upward, and the middle joint (proximal interphalangeal joint) bends downward. This bend is not to be confused with claw toe, where both the middle joint and the tiny distal interphalangeal joint at the end of the toe curl downward like a claw. Mallet toe occurs when the stuck bent shape is only at the distal interphalangeal joint at the end of the toe.
The most common cause of hammer toe is an injury to the toe from wearing high-heeled, tight, and/or pointy shoes. These types of shoes put severe pressure on the toes, pushing them out of balance. Less commonly, diseases of the brain like strokes and nerve, muscle, or joint conditions like rheumatoid arthritis or even numbness in the feet due to diabetes can cause hammer toe. Flat feet, high arches, or bunions can be contributing factors in developing hammer toe, particularly in the second toe. Genetic predisposition or an excessively long second toe are also contributing factors in developing hammer toe.
Take a break from or minimize how often you wear high heels. Dedicate some care to your toes by gently massaging them and applying ice to the affected toes to relieve pain and reduce swelling.
The keys to preventing hammer toe are caring for your feet and maintaining good circulation. Stretch and extend your legs and feet, wear properly fitted, roomy shoes, and give yourself a warm footbath whenever possible.
Add a daily exercise regimen for your feet. An easy exercise to try at home is picking up a towel, marble, or golf ball with your toes twenty times each day. This type of exercise will strengthen and increase the agility and mobility of your toes.
Attend to your foot health or the foot health of your child early in life. Foot problems in childhood, particularly in the first year, can be carried into adulthood and may lead to hammer toe. Cover your baby’s feet loosely to leave plenty of opportunity for kicking and toe movement. Do not push a child to walk too early, as this can contribute to developing problems in foot alignment.
If hammer toe is caught early, simply changing shoes or adding shoe insoles and gently stretching and strengthening the toes through exercise may correct the condition.
If the cause is inappropriate or ill-fitting footwear, compromise a bit of fashion for increased comfort and function. Wear shoes that are broad across the toes with a minimum of a half-inch of space between the longest toe and the tip of the shoe. If the cause is a high arch or long toes, wearing toe pads or insoles may help. If the hammer toe is severe and there is no ability to move the toes, surgery may be the only option to restore movement.