is a Z-shaped deformity caused by dorsal subluxation at the metatarsophalangeal joint. Diagnosis
is clinical. Treatment is modification of footwear and/or orthotics. The usual cause is misalignment of the joint surfaces due to a genetic predisposition toward aberrant foot biomechanics and tendon
contractures. RA and neurologic disorders such as Charcot-Marie-Tooth disease are other causes.
Hammertoes are usually structural in nature. Many times this is the foot structure you were born with and other factors have now made it so that symptoms appear. The muscles in your foot may become
unbalanced over time, allowing for a deformity of the small bones in each toe. With longstanding deformity the toe may become rigid. Sometimes one toe is longer than another and this causes a
buckling of the digit. A hammertoe may also be caused by other foot deformities such as a bunion. Trauma or other surgery of your foot may predispose you to having the condition if your foot
structure is altered.
A hammer toe may be painful, especially when irritated by a shoe. All four toe conditions may cause cramps in the toes, foot and leg due to the abnormal function of the tendons in the foot. If a
mallet toe has occurred, you are likely to suffer from a corn at the end of the toe. A hammertoe may cause a corn on the top of the toe. Infections and ulcers can also occur. In severe cases a mallet
toe, trigger toe, claw toe or a hammer toe may create a downward pressure on the foot, which can result in hard skin and corns on the soles of the feet.
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear
crooked or rotated. The involved joint may be painful when moved, or hammertoe
stiff. There may be areas of thickened skin (corns
or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the
best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for
healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are
usually performed in a weight-bearing position.
Non Surgical Treatment
To keep your hammertoes more comfortable, start by replacing your tight, narrow, pointy shoes with those that have plenty of room in the toes. Skip the high heels in favor of low-heeled shoes to take
the pressure off your toes. You should have at least one-half inch between your longest toe and the tip of your shoe. If you don't want to go out and buy new shoes, see if your local shoe repair shop
can stretch your shoes to make the toe area more accommodating to your hammertoe.
Extreme occurrences of hammer toe may call for surgery. Your surgeon will decide which form of surgery will best suit your case. Often, the surgeon may have to cut or remove a tendon or ligament.
Depending on the severity of your condition, the bones on both sides of the joint afflicted may need to be fused together. The good news is you can probably have your surgery and be released to go
home in one day. You will probably experience some stiffness in your toe, but it might last for a short period, then your long-term pain will be eliminated.
The best first step you can take is to evaluate your shoe choices. Ditch any shoes that aren?t serving your feet well. Shoes that crowd the front of your foot, especially around your toes, aggravate
the existing condition and can also cause the condition to develop. If you suspect the development of hammertoe, you may also try using protective pads to prevent irritation and the development of
corns. Custom orthotics to correct muscle imbalances in your feet may also help prevent hammertoe.