405.419.5610
Dr. Sheryl Smith
    Orthopedic Specialist
Although claw toes, hammer toes, and mallet toes are technically different, they behave and look similarly. Women are more likely to get pain associated with hammer toes than men because of the types of shoes they wear, but it is not only a female problem.  Hammer toes can be a serious problem in people with diabetes or poor circulation. People with these conditions should see a doctor at the first sign of foot trouble.

There are two types of hammer toes:

• Flexible Hammer Toes. If the toe still can be moved at the joint, it’s a flexible hammertoe. This earlier, milder form of the problem can probably be treated with a wider range of options.

• Rigid Hammer Toes. If the tendons in the toe become rigid, they press the joint out of alignment.  At this stage, the toe can’t be moved and it usually means that surgery is needed.
CAUSES
Hammer toe problems are usually genetic, and often the result of the wear and tear on a deformed joint. Sometimes wearing shoes that are too tight or too short is the cause of toe problems. Ill-fitting shoes can leave the toes with little room to relax. When the toes are scrunched, the muscles get out of balance and eventually learn to stay in a bent position. While the muscles contract the tendons also shorten. This makes it harder to straighten the toe. Over time, the toe muscles cannot straighten the toe, even if you are not wearing shoes.

Hammer toes can also be caused by trauma (stubbing the toe and producing a fracture or tear of the tendons that straighten or extend the toe).  More commonly, the deformity occurs slowly or chronically.  Neuromuscular diseases such as cerebral palsy, polio, Charcot Marie Tooth disease, stroke, closed-head injury, nerve injury, or other rare neuromuscular problems can cause hammer toes.  People with a very high arch may be prone to developing these conditions. Poor blood flow to the feet (from peripheral arterial disease) and having reducing feeling in the feet (peripheral neurpathy) from diabetes can also lead to toe problems.

DIAGNOSIS

Visual inspection and physical examination is usually all that is required to diagnose hammer toes. X-Ray may be used to evaluate the joint health.

SYMPTOMS

The most marked symptom of hammer toe is visual. Patients with hammer toe are easy to spot. The middle joint of the toe is bent downward so that it takes on an “L” shape. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe, but over time, the joint becomes immobile. The joint may be painful and it is not uncommon to see a corn or a callus on the top of the joint from rubbing against the inside of the shoe. Walking or wearing shoes can be painful

TREATMENT


While the joint is still flexible, a metatarsal bar can be shaped to fit under the toes to lengthen the tendons. Pads can also be used.  Choosing shoes with a wide toe box and plenty of length can lessen the discomfort. Advanced hammer toes that have become rigid and immobile are candidates for surgery. Toes can be surgically realigned and made straight again.  They can even be made shorter.  Depending on the severity and length of the toe, there are several methods to surgically correct a hammer toe. In general, the surgery involves removing a portion of the bone at the contracted joint, to realign the toe.
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OKFootMD   Dr. Sheryl Smith