The term hammertoe refers to when the smaller toes of the foot become contracted at one of the multiple joints of the toes. These deformities can vary in where the contracture takes place and the severity of the contracture.

There are three joints located in the toes. The first joint is at the ball of the foot. The second two are located in the toes. Hammertoes can affect each of these joints differently. At the first joint, or metatarsal phalangeal joint at the ball of the foot the joint is contracted up. Conversely, at the two joints in the toe, or interphalangeal joints, the joint is contracted downward. In severe cases all three joints are contracted. These are called claw toes. In the instance where the toe is only contracted at the joint near the very end of the toe the term mallet toe is used.

Other than the obvious cosmetic problem associated with hammertoes they can also cause significant pain. These contractures can cause arthritic changes and pain in the joints. Pain can also be caused by a shoe gear rubbing on the toes.

Often hammertoes are accompanied by calluses on the tops of the toes and balls of the feet. The calluses on the tops of the toes are normally due to rubbing of shoe gear. The calluses on the ball of the foot are due to increased pressure due to the hammertoes pushing down on the metatarsal heads.

Hammertoes are a progressive deformity. The cause of the hammertoes can be a number of different things. Flattening of the arches of the feet cause the tendons going to the toes to be imbalanced. When the tendons are imbalanced it causes one tendon to pull more and contract the toe in that direction. Over time the contracture becomes more and more severe. The more severe the deformity the more difficult it is to treat.

Conservative treatments for hammertoes are mainly focused on preventing progression of the deformity and accommodating the toes to prevent rubbing in the shoes. Preventing the progression is accomplished through arch support and splinting of the toes. Arch supports can be worn on a long-term basis; however splinting the toes often does not work due to inability to consistently splint the toes on a daily basis.

The surgeries to correct hammertoes involve shortening the bones and releasing the tendons and ligaments to straighten the toes. The surgeries are outpatient minor procedures. The majority of the procedures involved wearing a special shoe for approximately 2 weeks until the incisions are healed and the sutures are removed. However, in more severe cases a longer postop course may be required.

It is important to be evaluated early, before the problem becomes too severe and more significant treatment is required. I would recommend presenting to the office if you have any of the problems described above.