Hammertoes encompasses three different deformities of the toes. These deformities are called: hammertoe, claw toe, and mallet toe. The difference between these three is which of the joints are contracted (flexed) and the name reflects what the toe looks like.
There are 3 joints that make up the toe-the metatarsophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint. The hammertoe is contracted (flexed) at the proximal interphalangeal joint only, where as the mallet toe is only contracted (flexed) at the distal phalangeal joint only. The claw toe on the other hand is contracted (flexed) both at the proximal and distal interphalangeal joint. These contracted toes can either be rigid or flexible. This means that if you pull the toe and it goes straight it is a flexible deformity, but sometimes the toe will not stretch out in which case this is a rigid hammer digit syndrome.
Hammer digit syndrome is quite easy to diagnose since the deformity is clearly visible. However, x-rays are usually taken to view the bony structures of the toe and to clearly see which joints are contracted.
The most common symptoms of hammer digit syndrome include:
- Callus formation at the tip of the toe or on top of the toe
- If these calluses are exposed to constant excessive pressure-for example, the toe is continuously rubbing against the top of the shoe then there is a risk for the skin to break open causing a small ulcer.
- Aching pain in the toe, which is worse with walking or after standing for long periods of time.
- Aching pain may also keep you up at night
- Unable to put on shoes due to the toe being in the way
- A popping sensation in the joints
Hammer digit syndrome is caused by:
- Bunions-the big toe may be crossing over into the second toe’s area causing it to have to “curl” over the big toe. The second toe is the most commonly affected toe due to the presence of bunions, but also because it is the longest toe, which may lead to contracture in an attempt to become shorter to balance with the other toes.
- Too small of shoes-these cause the toes to be “scrunched,” which may lead to contractures.
- High heels-one possible reason for why hammer digit syndrome is more common in females.
- Congenital deformity
- Inflammatory arthritis
- Trauma to the toe
There is both non-surgical treatment and surgical treatment available to treat hammer digit syndrome, but which modalities you try is determined on an individual basis. The non-surgical treatment will not get rid of the contracted toe, but it works by making the toe feel better. Some non-surgical treatment options include:
- Changing shoe gear-avoid high heels and buy shoes that are wider to give the toes more room.
- Podiatrists can help with padding the shoe, as well as making orthotics to slow the progression of the deformity. Orthotics help slow the progression because the goal of orthotics is to provide a properly functioning foot.
- On a regular basis, podiatrists can also remove the calluses that may become painful.
- At home you can ice your toe and take over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen.
If these non-surgical treatments fail to provide relief from the pain that may be associated with hammer digit syndrome, there are numerous surgical procedures that a podiatrist can perform to both get rid of the pain and the contracted toe.