A hammertoe is a toe that's curled due to a bend in the middle joint of a toe. Mallet toe is similar, but affects the upper joint of a toe. Otherwise, any differences between Hammer toes
and mallet toe are subtle. Both hammertoe and mallet toe are commonly caused by shoes that
are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a hammer-like or claw-like
appearance. Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may
need surgery to experience relief.
A common cause of hammertoe and mallet toe is wearing improper footwear - shoes that are too tight in the toe box, or high-heel shoes. Wearing shoes of either type can push your toes forward,
crowding one or more of them into a space that's not large enough to allow your toes to lie flat. Hammertoe and mallet toe deformities can also be inherited and may occur despite wearing appropriate
footwear. The result is a toe that bends upward in the middle and then curls down in a hammer-like or claw-like shape. Your shoes can rub against the raised portion of the toe or toes, causing
painful corns or calluses. The bottom of the affected toe can press down, creating the mallet-like appearance of mallet toe. At first, a hammertoe or mallet toe may maintain its flexibility and lie
flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff.
Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin
problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most
common at the level of the affected joint due to continuous friction of the deformity against your shoes.
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination,
the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the
degree of the deformities and assess any changes that may have occurred.
Non Surgical Treatment
Prescription strength medicines to decrease pain and inflammation. Physical Therapy. To strengthen poorly functioning muscles and stretch tight muscles that may be exacerbating the toes. Special
ultrasound techniques may reduce inflammation. Custom Foot Orthotics. An orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort and prevent future
progression. Toe Splints or Pads. Specific pads may prevent pressure and physical irritation in shoes. Toe splints and toe spacers physically realign the toes and can lessen pain and halt or stall
hammer toe progression. Cortisone injections are strong anti-inflammatory agents to decrease pain, and swelling directly at the toe region. Injections only treat the symptoms, and in some cases used
in caution (and sparingly) they can weaken supporting ligaments of Hammer toes
Probably the most frequent procedure performed is one called a Post or an Arthroplasty. In this case a small piece of bone is removed from the joint to straighten the toe. The toe is shortened
somewhat, but there is still motion within the toe post-operatively. In other cases, an Arthrodesis is performed. This involves fusing the abnormally-contracted joint. The Taylor procedure fuses only
the first joint in the toe, whereas the Lambrinudi procedure fuses both joints within the toe. Toes which have had these procedures are usually perfectly straight, but they take longer to heal and
don't bend afterwards. A Hibbs procedure is a transfer of the toe's long extensor tendon to the top of the metatarsal bone. The idea of this procedure is to remove the deforming cause of the
hammertoes (in this case, extensor substitution), but to preserve the tendon's function in dorsifexing the foot by reattaching it to the metatarsals. Fortunately, the Gotch (or Gotch and Kreuz)
procedure--the removal of the base of the toe where it attaches to the foot, is done less frequently than in years past. The problem with this procedure is that it doesn't address the problem at the
level of the deformity, and it causes the toe to become destabilized, often resulting in a toe that has contracted up and back onto the top of the foot. You can even have an Implant Arthroplasty
procedure, where a small, false joint is inserted into place. There are several other procedures, as well.
To prevent a hammertoe, never squeeze your toes into shoes that force them to bend unnaturally. Those tendons can tighten up, and leave a permanent, claw-like bend in your toe. Always slip your feet
into soft, roomy shoes that easily accommodate all of your toes. Stretching your toes can also help keep the tendons in the toes relaxed, and prevent a hammertoe. Use your hands to gently straighten
and stretch your toes or try to pick up objects with your toes, grabbing something from the floor, for example. Sitting on a blanket and using your toes to grab the ends with also relax your feet.