Hammer Toes – Causes and Treatment

What are Hammer Toes?

Hammer Toes are a deformity of the toe which causes the toe to stick up and rub on footwear. This causes pain and presents a problem whenever buying or wearing shoes.

Hammer toes usually affect the second toe, but can also affect the third or fourth toes.

In this article I will cover:

What Causes Hammer Toes?

A hammer about to hit a toe, not what we mean.

Some of the most common causes of hammer toe are:

  • Ill-fitting shoes,
  • A bunion on the big toe (hallux abducto-varus),
  • Arthritis – including osteo, psoriatic, rheumatoid, and reactive,
  • Stroke.

Ill-fitting Shoes

Shoes can cause Hammer Toe for a variety of reasons.

They can be too small, the wrong shape, or they may be unsupportive causing the muscles of the feet to over-work which can lead to hammer-toe.

Shoes that are too small place pressure on the end of the toe, effectively pushing it backwards and causing a bend.

Pointy shoes cause toes to crown in on each other which can also cause the second toe to bend and become a hammer toe.

High heeled shoes force all of the body weight down into the front of the foot, causing increased stress on toe joints, often leading to hammer toe.

High heels often have the double whammy effect of pointy toes as well!

Bunions Can Cause Hammer Toe

Bunions are another very common cause of hammer toes in the second toe.

As you can see in the picture to the right, the bunion is causing the big toe to push on the side of the second toe which in turn is bending up through the first joint (proximal inter-phalangeal joint).

To correct this surgically you would need to treat the cause – the bunion – as well as the result – the second hammer toe.

Shows a bunion causing a hammer toe.

Arthritis - Osteo, Rheumatoid, Psoriatic Etc.

Most types of arthritis can cause a hammer toe to form.

Rheumatoid can especially lead to bunions, which in turn can lead to hammer toes.

This is because it tends to attack the joints where the toes attach to the feet – the metatarsal-phalangeal joints.

Osteo-arthritis can also cause hammer toes as it is a wear-and-tear type of breakdown of the joints which can cause permanent damage to the small joints of the lesser toes.

To read more about how arthritis can affect the feet click here.

Stroke and Hammer Toes

One of the less well known causes of hammer toes is a stroke.

A stroke is where part of the brain gets damaged, either by a lack of blood supply to the area due to a clot, or a bursting of a brain artery also know as an aneurysm.

If the damaged area is responsible for working the muscles that control the foot or lower leg, an imbalance in muscle strength can follow.

This can lead to certain muscles over-powering others which can lead to toes being permanently held in a flexed position. Over time the joints become more rigid and there is no correcting of the toe without surgery.

Hammer Toes Complications?

Because the proximal joint of a toe with hammer toe is often rigid, it causes a lot of problems, particularly with footwear.

As the joint does not give, the skin and soft tissue often has to absorb the stress caused by a rubbing or pressing shoe.

At first this will often present as an area of redness that looks a little bit swollen, and maybe a small blister.

As time goes on, callous will start to form. Callous is a protective mechanism of the body of laying down extra layers of keratin to protect an area under stress. Before long the callous becomes its own problem as the layers get thicker.

Thick layers of callous will form a focal point over the top of the joint which becomes a corn (basically a nucleus of concentrated callous) which can be very painful and need regular removal by a podiatrist. To learn more about corns click here.

The final stage of this process is breakdown of the skin leading to an ulcer.

Ulcers are particularly dangerous if you have a chronic illness that affects the lower limb especially diabetes and peripheral vascular disease.

These ulcers can take months of treatment and are very dangerous if left alone as they become infected.  To learn more about diabetic foot complications click here.

As you can see in the second photo below, hammer toes can also cause callouses and corns under the feet which could also become ulcers.

A pair of feet with severe arthritis

A hammer toe deformity in which the toe is fixed in that bent down position can cause pain when shoes rub  on the toe joint.

This rubbing can result in inflammation, corns, calluses or ulceration.

Hammer toes can increase the amount of forefoot pressure resulting in calluses to form on the ball of the foot.

What Can You Do For Hammer Toes Yourself?

There are several things that you can do yourself to either prevent hammer toes in the first place, or improve your hammer toes.

Some of these measures include:

  • Making sure that all of your shoes are appropriate and fit well,
  • Strapping method for hammer toes,
  • Wearing guards when wearing shoes,
  • Night splints,
  • Calf stretches and foot muscle stretches.

Footwear

Here are some things to consider with footwear:

  • The heel should not be higher than 2.5cm (1 inch). Otherwise the weight of the body is on the front of the foot too often and places tremendous forces on the toes.
  • The toe-box shape of the shoe should fit the shape of your foot.
    This sounds totally logical but too often we choose shoes that don’t fit well to our foot shape.
    Whether they are too pointy or too rounded, they can put pressure on your toes.
    So have a look to see what type of shape the front of your foot is, and get advice from a salesperson as well.
  •  Get properly fitted by a salesperson with a Brannock device. 
    But don’t just trust their advice, it must feel really good for you in the shop, so have a good walk around for a few minutes before deciding to buy.

Strapping Method:

Here is a reasonably simple strapping method that you can do in the early stages of hammer toes developing.

 

How Can A Podiatrist Help With Hammer Toes?

Conservative treatment is usually able to relieve pain and symptoms of hammertoe and can include:

  • Footwear advice (to ensure shoes have enough depth and width in the toe box)
  • Supportive orthotics (to reduce the amount of pressure on the hammertoe)
  • Debridement and offloading of corns and calluses
  • Anti-inflammatory medication may be recommended in some cases
  • Braces

Non-surgical treatment can help to relieve pain, but will not straighten or correct the hammertoe deformity.

If conservative treatment is not successful then surgery may be recommended to straighten the toe.

Book an appointment with our Podiatrist at Dynamic Podiatry if you are experiencing any problems with hammertoes by calling 3351 8878 or click on the Book Now button.

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