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Hammertoe

 

Hammertoe is a common condition in the United States with more than 200,000 cases of hammertoe being treated every year. Hammertoe is caused by shoe choice, most commonly by shoes that have high heels and narrow toe boxes. Because of this, women are much more likely to develop a hammertoe than are men.

Genetics also play a role in whether or not a person will develop hammertoes during their lifetime. If parents or grandparents suffered from hammertoes, a person is much more likely to develop them, as well. Patients with diabetes or Rheumatoid Arthritis are also at greater risk of developing the condition.

The primary cause of hammertoes, however, is shoe style. High-heels and shoes with narrow toes force the toes into unnatural shapes and make developing the condition much more likely. Understanding risk factors that make a person more likely to develop hammertoes can help you determine whether your shoe choice is worth the risk.

Symptoms of Hammertoes

Hammertoe is a deformity of the smaller toes. The big toe is almost never affected by hammertoe. Hammertoe can affect either one or both of the joints of the toe and usually starts out as a mild bending of the toe. The deformities are slight at first, getting worse over time until the toe resembles a hammer or upside-down V.

Symptoms of Hammertoe Include:

  • Pain – The toes are painful and irritated, especially when wearing shoes.
  • Calluses – Calluses build up on the toes or on the ball of the foot.
  • Corns - Corns are layers of skin that form on the toes at places of friction. Similar to a callus, corns may be hard or soft, depending on where they are located.
  • Redness & Swelling – The toes may be inflamed and have a reddish color or a burning sensation.
  • Sores – In advanced cases, the toes may form sores that won’t heal until the condition is addressed.
  • Contracted Toes – The most obvious symptom of hammertoe is the shape of the toes themselves. The affected toes are pushed back toward the foot, with the middle joints pressed upward, forcing the toe into the shape of an upside-down V.

Early Intervention is Key for Hammertoes

In the early stages, hammertoe is very treatable. But, if left untreated, the toes will become rigid and unable to return to their normal position without surgery. Hammertoes won’t improve without intervention and will progress until wearing shoes becomes nearly too painful to bear and surgery is required.

Early intervention may be as simple as changing the style of shoes that are being worn. Shoes that force the toes back toward the foot, either because they are too small or because of a narrow toe box, are the primary cause of hammertoes. Finding shoes that fit properly and allow the foot and toes to maintain their natural placement are key to preventing the condition from progressing.

Diagnosing Hammertoes

A visual inspection will nearly always lead a podiatrist to a diagnosis of hammertoe, as the condition is readily apparent. However, a doctor will need to complete a full examination of the patient and their medical history to rule out any other causes or co-existing conditions that should be addressed.

During the examination, the doctor may ask the patient about their shoe wear choices and will study the shape of the foot and the contractures of the toes. X-rays may be necessary to rule out any other causes or conditions. Once a diagnosis has been reached, a personalized treatment plan can be developed. Hammertoes won’t get better on their own, but not all cases of hammertoe require surgical intervention.

Treatment for Hammertoes

Your podiatrist, Dr. Kleis has a number of non-surgical therapies to choose from when forming a treatment plan for hammertoes. What course is to be taken will depend on the severity of the condition and the responsiveness of the patient’s toes.

Non-surgical Interventions Include:

  • Padding for corns and calluses – To treat the coexisting conditions of corns and calluses on your feet and toes, your podiatrist may prescribe medicated or over the counter pads that can shield your corns and calluses from further irritation and aid in healing.
  • Changes in Shoewear Choices – A change in shoe wear is almost always necessary. Shoe styles are the primary cause of hammertoes forming and the condition cannot be addressed without avoiding those shoes that make the condition worse. It’s important to choose shoes that are wide enough for your feet, the correct length so that toes have room to move at the end of the shoe, and with a wide enough toe box that the toes can remain in their natural position.
  • Orthotic Inserts – Occasionally a custom orthotic insert may be required to ease the muscle/tendon balance in your foot. Specially made, orthotic shoes may offer some relief, as well.
  • Injection Therapy – Corticosteroid injections are sometimes necessary to relieve the pain and swelling of hammertoes.
  • Anti-inflammatory Medications – Non-steroidal anti-inflammatory medications, like ibuprofen or naproxen, may be prescribed for swelling and pain.
  • Splinting the Toe – Splints for the affected toe may help to straiten the toe while you sleep.
  • Exercise – Strengthening exercises and stretching can help to keep the toes more flexible, which reduces the painfulness of the condition.

Surgery For Hammertoe

In cases where surgery is required, Dr. Kleis can usually do the procedure in the office, under light sedation. Surgery is only required when the toes are too stiff, can’t be moved, and the pain is too much for the patient to be able to wear normal shoes. The surgery is almost always successful and the discomfort to the patient is minimal.

Hammertoes in Individuals with Diabetes

Hammertoes occur when there are muscle and ligament imbalances around the toes, causing the toes to buckle, forming a hammer or upside-down V. For people with diabetes, hammertoes can be a serious problem because they run a higher risk of foot ulcers and infections, as well as slower healing time due to the disease.

Preventing Hammertoes

You can avoid ever developing hammertoe, along with many other feet and ankle problems, by choosing shoes that fit correctly and offer the proper support. 

When buying shoes, look for:

  • Plenty of Room – Don’t choose shoes that are too short or have a narrow toe box. 
  • Avoid High Heels – Low heeled shoes will help you avoid back problems along with avoiding hammertoes. 
  • Shop For Shoes At The End of The Day – Your feet have a tendency to swell throughout the day. By shopping at the end of the day, you will ensure that your feet will have plenty of room.
  • Check Your Shoe Size – Just because you wore a 6 ½ in high school doesn’t mean you still wear a 6 ½. Your feet continue to grow as you age and extra weight can force your foot to spread. Check your shoe size every so often to be sure you’re getting the correct size shoe. 
  • Proper Fitting Shoes – Don’t go for the smaller size just because it’s attractive. Choosing a shoe that is the correct size is vitally important in avoiding hammertoe. 

Hammertoe FAQs

What is a hammertoe?

A hammertoe deformity occurs when the toe joints bend abnormally to resemble a hammer, or an upside-down V when viewed from the side. This podiatric condition can affect any toe but is most common in the second through fifth toes.

In the early stages, a hammertoe may retain its flexibility and range of motion at the joint. Flexible hammertoes are less serious and easier to treat than rigid, or inflexible hammertoes.

Cases of hammertoes that remain untreated for a long time or occur in women and men with arthritis may result in a loss of flexibility. Surgery is usually the only treatment for rigid hammertoes.

What causes hammertoe?

The most common cause of hammertoe involves an imbalance in the muscles and tendons in the toe. Common causes of the muscle imbalance in the foot include:

  • Genetic variations in foot structure
  • Previous injuries or foot trauma
  • Arthritis of the foot
  • Wearing tight-fitting shoes can aggravate muscle imbalance and lead to hammertoe. 

What are hammertoe symptoms?

Hammertoes are progressive, so your symptoms get worse and don’t resolve on their own. Common signs and symptoms of hammertoe include:

  • Pain or irritation while wearing shoes
  • Inflammation or redness
  • One or more abnormally bent toes
  • Corns or calluses on the toes or ball of the foot
  • Restricted motion in the toe joint

Over time, the toe can become rigid and develop open sores that may become infected. This condition never improves without treatment, that’s why it’s best to schedule an appointment with Dr. Kleis as soon as you notice symptoms of hammertoe.

How do you diagnose and treat hammertoe?

First, Dr. Kleis performs a thorough physical exam and review of our medical history. He may try to reproduce your symptoms by moving your toe with his hands. Dr. Kleis may also take an X-ray to determine the extent of your condition and check for signs of joint damage.

Finally, he develops an individualized treatment plan that may include:

  • Changing to roomier footwear
  • Padding or trimming corns and calluses
  • Wearing custom orthotic footwear or devices
  • Oral or injectable anti-inflammatory medications
  • Splinting the affected toe

For a flexible hammertoe, often a simple 10-minute surgery in the office can straighten the toe.

For expert hammertoe treatment from a professional who takes the time to answer your questions and explain procedures and treatments in detail, call or book an appointment online with Dr. Kleis today.

 

 

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