What are Deformities of the Toes?
The foot is a highly mechanical apparatus, made of many bones and other coordinated structures. The foot carries the entire weight of the body and propels us forward when we stand, walk, and run. Several common deformities of the toes claw toe, hammer toe, and mallet toe often cause pain and a loss of function in the use of the foot. Failure to treat these conditions may contribute to the development of serious and disabling changes in habitual ways of walking and carrying the body.
Claw toe, mallet toe, and hammer toe are all deformities of the toes. While they are somewhat similar in appearance, each has specific characteristics. Variations in the three conditions are caused by differences in the direction the joints of the affected toes bend, as well as in degrees of deformity.
Toe deformities are often congenital, occurring for example, in some people with muscular dystrophy. People with high arches, or those who have a tendency to rotate their feet inward while walking are susceptible to deformities of the toes, as are those with rheumatoid or osteoarthritis and people with diabetes.
Proper evaluation is the first step in understanding toe deformities and the problems they present. Seeking early evaluation for disorders of the toes and feet is always a good choice, and can make a significant difference in controlling the condition.
What is Hammer Toe?
Hammer toe is caused by an inherited muscle imbalance or abnormal bone length. It may occur in children who outgrow their shoes rapidly. In this condition one or more small toes buckle when the middle joint (the PIP joint) contracts. This causes the tendons to shorten.
A foot with a bunion will often have a hammer toe also. Over time, the bunion slants the big toe toward and then under the second toe, the most frequently hammered toe. This forces the second toe to rise into a claw-like position.
A hammer toe can lead to severe pain and pressure. Like claw toe, it creates extra stress in the ball of the foot, often leading to the development of corns and calluses.
Causes of Hammer Toe
The main cause of hammer toe is wearing tight shoes that crowd the toes, or high heels. It may also be brought on by an injury.
The cause of the condition is a tightening of the ligaments and tendons of the toe, causing a buckling of the joint of the toe. The result is a cocking of the toe upward, whereas in a normal foot, the toes lie flat. Shoes can then rub on the top of the cocked toe, eventually causing painful corns or calluses. If the deformity is not treated, the toe may become permanently fixed and rigid.
A hammer toe may also develop because of:
- Adeformity of the foot that is present at birth, causing tight tendons in the affected toe
- Acongenital misalignment of bones in the arch of the affected foot
- Failing to replace the shoes of children whose feet have outgrown them
- High heels and other restrictive shoes
- Joint inflammation, such as that caused by arthritis
- Damage to the muscles and nerves of the foot from a long-term disease like diabetes an injury
- Symptoms of Hammer Toe
Besides pain and its claw-like appearance, symptoms of hammer toe include:
- Changes in gait and balance
- redness and swelling on and around the affected toe
- corns or calluses where the toe bends and rubs
- infections may develop
- ulcers sometimes develop in patients with diabetes, who have decreased sensitivity in the foot
- it may be difficult to find shoes that accommodate the deformity
Treatment of Hammer Toe
Treatment for hammer toe can be as simple as having the corn that has developed on the toe trimmed by a doctor to relieve pain and swelling. If a bunion is present, that condition may require specific treatment. Other recommendations may include:
- Regularly using a pumice stone on calluses
- Wearing shoes or sandals that give your toes plenty of room
- Using protective padding on the hammer toe to prevent irritation
- Wearing special shoes that conform to the shape of the foot and support the hammer toe, making it more comfortable to walk
- Wearing shoes or shoe inserts (orthotics) that correct the hammer toe
- Wearing soft pads over the corns or calluses
- Strengthening toe muscles with exercises such as picking up marbles with the toes and stretching exercises
If the hammer toe has become is rigidly fixed in an inflexible position, surgery may be required. The goal of surgery is to realign the toe and improve function or to lengthen the tendons by removing part of the proximal phalanx in older patients. Procedures may include:
- Releasing a tendon that is too short
- Transferring a tendon to another place
- Insertion of a steel pin to correct the position of the toe
- If surgery is required, a period of several weeks in an open-toed surgical shoe that acts like a cc will probably be needed.