Hammertoe: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Outlook

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feet with Hammertoe

1Overview

A hammertoe is a deformity that usually affects the second, third or fourth toes. This condition happens when there is an imbalance in the ligaments, tendons or muscles that normally hold the toe straight. In this condition, the toe is bent in the middle, making it look like a hammer, thus its name.

The main problem in a hammertoe is a chronic and sustained imbalance between the extension and flexion force of the lesser toes from extrinsic forces, intrinsic forces, or both.

People with hammertoe may have calluses on the top of the middle joint; this is due to its friction with footwear. As a result, individuals with this type of deformity may have a hard time finding comfortable shoes. Hammer toes are flexible in the early stages and can be corrected with simple procedures, but if it’s left untreated, it may lead to a full-blown deformity.

2Types of Hammertoe

Flexible Hammertoe

This type of toe can still be moved at the joint, which means it’s flexible. This is when the disease is at its earlier stages.

Rigid Hammertoe

A rigid hammertoe happens when the tendons in the toes become hard or rigid. As a result, they press the joint out of alignment. This means that the disease is at the later stages already when the joint can’t be moved and the only treatment needed is surgery.

3Symptoms

The symptoms of a hammertoe depend on the severity of the condition. Flexible hammertoes are tolerable, and sometimes, they are asymptomatic, which means that they do not manifest any symptoms yet. On the other hand, a rigid hammertoe may entail more discomforts like pain and swelling, especially if it touches your shoes.

The main symptom is a bent toe, like a hammer. Other symptoms of a hammertoe include:

  • Pain on the affected toe, especially when wearing shoes
  • Inflammation or a burning sensation on the bent toe
  • Corns and calluses
  • Toe contracture
  • In severe cases, open sores, resulting from the constant friction against the shoe.

4Causes

The most common cause of hammertoe is a muscle or tendon imbalance, wherein it leads to the toe being bent. The condition may also worsen by shoes that do not fit properly.

Basically, there are three parts of the toe joint that work together to keep it straightened. The muscles, ligaments, and tendons keep the toes straight. If one of these elements becomes weak, the muscles become tight and the toe can’t straighten out.

There are many factors that can contribute to this condition, which includes:

Certain Shoes

Wearing shoes that do not fit properly or high heels can force the toes into a flexed position. When the shoes are repeatedly worn, the toes will not straighten out, even if the person isn’t wearing any footwear.

Trauma

When there is an injury that can affect the toe, this m ay leads to the development of a hammertoe.

The abnormal balance of the toe muscles

This imbalance may lead to instability, making the toes contract.

5Risk Factors

There are some factors that could increase your risk of developing hammertoe:

Gender

Women are more likely to have hammertoes than men.

Age

People who are older are at a heightened risk of developing hammertoe.

Genetics

In some cases, having hammertoes can be hereditary.

The length of the toe

Sometimes, when the second toe is longer than the big toe, there is a higher risk of having a hammertoe.

Underlying diseases

There are certain diseases that could lead to a hammertoe, including arthritis and diabetes. People with diabetes can be at a heightened risk of developing a hammertoe. If a toe has corn or ulceration, it means that there is excessive pressure on the toes.

6Complications

Hammertoe is a progressive disorder, which means it will worsen in time. If it’s not treated properly, the joint in the toe may become fixed. As a result, surgery will be the only treatment option to straighten it back to normal.

Initially, even with a hammertoe, the toe might maintain its flexibility. However, if the tendons of the toe become tightened, the toe can be permanently bent.
Other complications include calluses on the toe because of the friction against various footwear.

Another possible complication is limited mobility brought about by pain and inflammation. Normally, walking or running is easy, especially if you’re using the proper footwear.
In a person with a hammertoe, however, may feel burdened to walk or run, because the toe touches the footwear. This may lead to swelling, inflammation and the formation of blisters, which can be extremely painful.

7Diagnosis

To provide a diagnosis for hammertoe, it is important for the doctor to conduct a thorough medical examination. A hammertoe happens from a ligament and muscle imbalance around the toe joint. The middle toe joint will bend and become stuck like this. The most common complaint of people with hammertoe is the irritation on the top of the bent toe, most likely because of it rubbing against the shoe.

To confirm the diagnosis, the doctor may request for an X-ray to see the bones and joints of the toes.

8Treatment

When the toe is still flexible, the physician may recommend changing from tight and uncomfortable shoes to roomier and more comfortable footwear. The doctor may also advise the use of orthotics or shoe inserts to reposition the toe, relieve pressure and reduce the pain.

If you have a hammertoe, you need to seek medical advice immediately. While the treatment procedures are not yet implemented, here are some ways to do in the meantime:

  • Wear shoes that are high and broad across the toes. Make sure your footwear is comfortable, loose and has at least 1.5 centimeters of space between the longest toe and the tip of the shoe. Hammertoe is often seen in people with long toes.
  • Massage the toe gently to relieve the pain.
  • Wear proper shoes for the activity you’re doing
  • Do not wear high-heeled shoes that are 5 centimeters or more
  • Use hammertoe pads which reduce painful pressure on the toe
  • Pain on the affected toe, especially when wearing shoes

Other Treatments:

Hammertoe Surgery

A hammertoe surgery is needed to fix the toe joint. This is usually recommended for patients who have tried everything, but they couldn’t ward off the discomfort they are feeling.

The goal of the surgery is to relieve the pain and discomfort brought about by a rigid hammertoe. If this condition does not respond to the usual treatment options, the doctor may recommend surgery.

Often, a hammertoe correction happens as an outpatient procedure. This means that the patient can go home on the same day of the surgery. The doctor may perform the surgery either by making you fall asleep or giving you medicines to feel numb in the area of the discomfort.

What happens after surgery?

The doctor may give a special shoe to wear after the surgery. This shoe will help with walking. Normally, recovery may take a few weeks, depending on the type of surgery performed. During the early stages of recovery, the feet are elevated at the level of the heart.

Crutches or walkers could be a great help, especially during the first few weeks after surgery. However, there are a few complications the patient should look out for including infection, bleeding, the formation of blood clots, risks related to anesthesia use and damage to the nerves and blood vessels.

9Prevention

To prevent the progression or development of hammertoe, here are prevention tips:

  • Wear sensible shoes – like those with a loose top and you can use a non-medicated padding along with the appropriate shoes.
  • Use a pumice stone to deal with the formation of a corn or callus. A pumice stone may be used to reduce its size after a warm bath.
  • Perform foot exercises. Patients with a hammertoe can engage in various exercises that aim to strengthen the muscles that move the toe joints.
  • Splinting the toe may aid in the very early stages of a hammertoe.
  • Always check your feet frequently. This is important if you have diabetes or any disease that leads to poor circulation on the toes.
  • Promoting good circulation is important. When you’re sitting for a long time, you can stretch your legs, put your feet up or have a foot massage.

10Outlook

Hammertoe is a progressive disease. This means that as the condition worsens, the more you’ll have a problem with mobility, pain, and inflammation. Thus, it is important that the doctor will provide treatment for your condition early on.

When the toe is still flexible, it can be treated and managed easier, compared to having a rigid hammertoe. After treatment of the cause of a hammertoe, the condition usually goes away without any complications. However, when you waited too long to seek medical help, it can cause the other toes to become deformed too.

This is because the hammertoe exerts forces to make the surrounding toes go out of position. Hence, it is necessary and vital to get treatment as soon as the patient has been diagnosed with a hammertoe.