Foot Conditions A-Z

Hammer Toe

A hammer toe is a deformity of the second, third or fourth toe in which the toe becomes bent at the middle joint; hence, it resembles a hammer. Claw toe and mallet toe are related conditions. While a hammer toe is contracted at the first toe joint, a mallet toe is contracted at the second toe joint, and a claw toe is contracted at both joints.

According to the  2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 3 percent of U.S. adults age 21 and older (about 7 million people) have experienced hammer toe or claw toe. The condition is significantly more prevalent in females than in males.

Causes

The main cause of hammer toe is poorly fitted and/or poorly designed footwear. any footwear that is too tight in the toe box, especially high-heeled shoes, can push the toes forward, crowding one or more of them into a space that is not large enough to allow the toes to lie flat and spread as they should. Other causes include the following:

• Changes in foot anatomy.  Sometimes the metatarsal bones in the ball of the foot can “drop,” creating a situation in which the toes do not make contact with the surface of the shoe.  The toes may then contract at one or both of the joints to re-establish contact with the surface.
• Traumatic injuries in which toes are jammed or broken.
• Diabetic neuropathy. This can cause abnormal foot biomechanics due to nerve and/or muscle damage.
• Damage to nerves and muscles from other conditions, such as arthritis or stroke.
• Heredity.

Prevention and Treatment

To help prevent hammer toes from developing, wear shoes or boots that provide sufficient width in the toe box to ensure minimal compression. Use inserts that help the toes flatten out and spread and give sufficient support to the metatarsal arch in the forefoot. If hammer toes have already formed, padded socks help protect the tops and the tips of the hammer toes and may reduce pain from rubbing and chafing.

If the affected toe is still flexible, changing to footwear with a larger toe box and lower heels can allow the toe to realign itself and help reduce pressure and pain. If the toe has some limited flexibility, a podiatric physician or foot specialist may be able to straighten it simply by making an incision and releasing the tendon.

To ensure feet are optimally protected, IPFH suggests that you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot due to impact, pressure and shear forces.

Medical Considerations

Hammer toes can result in pain and difficulty in moving the toe. Corns, calluses and blisters can occur from the rubbing of the contracted toe against the inside of the footwear. Both hammer toe and mallet toe can cause pain during walking, running and other activities.

If left untreated, the tendons of the toe may contract and tighten, causing the toe to become permanently stiff and contracted. A podiatric physician or surgeon may have to cut or realign tendons and/or remove pieces of bone to straighten the toe. This may require that the bones be fixed temporarily with pins while the toe heals.

If you suspect you have a hammer toe, mallet toe or claw toe developing, talk with your doctor. Always talk to your doctor if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.  Also consult with your doctor if you have any reason to suspect that your foot problems are the result of a more serious underlying condition.