Definition A hammertoe is a foot condition in which the one or more of the joints of the toe is permanently contracted, or curled under. This forces the toe into a claw-like position. This condition can affect more than one toe, but is most common in the second toe, which is the toe next to the big toe.
What is going on in the body? Hammertoes are caused by a contraction of the joints. Hammertoes can be either rigid or flexible. Flexible hammertoes are more responsive to nonsurgical treatment than toes that are rigidly contracted and cannot be pressed flat. The condition can cause chronic pain from the rubbing of the toe knuckles on the inside of the shoes. If the skin breaks down and becomes blistered or ulcerated, an infection can develop. This can cause pain and swelling. In severe cases, a bone infection known as osteomyelitis can occur, which could require the toe to be amputated.
What are the signs and symptoms of the condition? The knuckles on a hammertoe often rub against the shoe. This creates painful calluses.
Occasionally, the toes are so twisted that one toe rubs against the toe next to it. This also produces painful corns or calluses.
What are the causes and risks of the condition? Hammertoe can be congenital or acquired from constantly wearing tight or ill-fitting shoes. Pulling socks on too tightly so that the toes are compressed into a contracted position can cause hammertoes, as well. Acquired hammertoe is commonly found on both feet and often develops in children who rapidly outgrow their shoes. Hammertoe can also be brought on by a tight tendon, muscle weakness or arthritis.
What can be done to prevent the condition? The condition can be prevented by wear properly fitting shoes. Shoes should be not be too narrow or too short. Also, care should be taken when pulling on stockings so that the toes are not buckled. If hammertoes are identified early, arch supports and prescription shoe inserts can sometimes keep the problem from progressing.
How is the condition diagnosed? Hammetoes are diagnosed by observing the contracted and deformed position of the toes. They can also be identified by painful corns and calluses that are often associated with them.
What are the long-term effects of the condition? Long term effects usually consist of chronic pain and discomfort. People who have reduced sensation in their feet, such as individuals with nerve damage from diabetes known as diabetic neuropathy, may not realise that the skin on the toes is breaking down. This can lead to serious infection and the potential loss of the toe, foot, or even the leg.
What are the treatments for the condition? Treatment can be as simple as selecting roomy socks and shoes with enough toe space to prevent knuckles from rubbing against the shoe material. Also, the areas that rub can be cushioned with corn pads to prevent calluses and blisters. Flexible hammertoes can sometimes be straightened out by splinting them for several months. Occasionally, the contraction of the toes can be controlled by using arch supports and prescription shoe inserts. When conservative measures fail to bring relief, the toes can be straightened surgically. This operation often has good results.
What are the side effects of the treatments? Potential complications of surgery to straighten the toes include:
risk of toe joints contracting again
infection following the operation. This may need to be treated with oral antibiotics or, in severe cases, hospitalisation and IV antibiotics.
chronic swelling. This occurs because the soft tissue over the toe bone is very tight. The problem can usually be managed with physiotherapy or steroid injections.
What happens after treatment for the condition? If surgery was needed to correct this condition, the person may need to use crutches for a few days after surgery. An open toed shoe should be worn until the pain and swelling has decreased. Analgesics such as paracetamol are used to treat post-operative pain. The feet should be kept elevated to decrease swelling.
How is the condition monitored? The person can monitor symptoms, and report changes to the doctor.
Author: Bill O'Halloran, DPM Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
