What are Hammer Toes?

A multitude of terms are commonly used to refer to deformities of the toes. Hammer toes are one of the most frequently seen, but how can one know if their toe is affected? And is it the same as a Mallet toe?

Mr Malagelada treats hammer toes and shares his expertise about this condition, why it happens, and what are the best available treatments.

What are Hammer toes?

A Hammer or bent toe is a deformity of the joints of the small toes (normally the second, third, fourth) causing them to bend, resembling a hammer. In each of these toes there are 3 joints through which movement happens, but when affected these joints can become permanently bent or stiff. 

Similar deformities are found with other names like mallet toe, claw toe, cross-over toe, and curly toe. The difference between them lies on the number of joints affected and the direction of the deformity. In a hammer toe, the abnormal deformity is in the middle joint, whereas in a mallet toe it is in the joint closer to the nail.

The normal history of these deformities is typically one of progressive increase in severity. To start with, a subtle lifting off the floor can be noticed in one or more toes. As the deformity progresses with time, an established bent toe will develop. Initially the toe is still flexible and can be manipulated back to a straight position. In the course of months or years, the flexible toe will become fixed in the deformed position and it will prevent a return to a normal position.

What are the causes?

Toe deformities occur due to an imbalance in the muscles and ligaments of the affected joint, which in normal circumstances are meant to keep the toe straight and move it throughout the normal range.  This imbalance can be due to a deformity in the big toe such as a bunion, and these two conditions are usually seen together. Certain shoes can also take the blame, with high-heels or pointy toe boxes being aggravators to the condition as there is not enough room in the shoe with crowding of the toes. Women are more likely to develop bent toes and genetics may also play a role.  

Options for treatment

The treatment of deformed toes will depend on the severity and the level of discomfort. As every patient is different, we tailor the treatment to each patient’s needs and preferences. Broadly speaking, the options in terms of treatment range from footwear modifications that accommodate for problematic toes, all the way to surgery. 

The type of shoes worn will make a difference in the symptoms caused by hammer toes. Any shoes that feature a narrow toe box are likely to rub on the bent toe and cause irritation, which eventually will form hard skin on the affected area. Filing the skin down is a temporary measure but as long as the deformity persists, the hard skin will return. A good way of avoiding this is by wearing shoes that leave enough space for the toes not to be squeezed. Well-padded and comfortable shoes are the first line of treatment that will enable sustained pain relief. 

In addition to the type of shoes, there are orthotic devices available to provide further comfort. The aim is to cushion prominent areas in the toe, usually those bent joints at the top, with silicone padding that is worn inside the shoes like a sock. Some of these orthotic devices are also designed to straighten the toe and reduce the bent. This is something that can also be accomplished with taping or splints providing that the toe is flexible. Once the toe adopts a fixed or rigid deformity, it will not be straightened easily with any external devices.  

How to fix a hammer toe?

Orthotics and footwear modifications will normally treat the symptoms of deformed toes but are bounded by their limitations. Given the constant pull and imbalance imparted by the muscles, the bent toe will continue to be bent unless these deforming forces are addressed. No matter what type of orthotic is used, as soon as it is removed the original deformity will appear back. If a definitive treatment is sought, the only option to predictably afford this is surgery.

During the initial stages of a hammer toe deformity and provided that the joint is still flexible, cutting the tendon can release a deformed toe. In more severe cases, further releases can be required which involve joint and bone cuts until a straight and corrected position is achieved. Those cases where the joint has become permanently fixed, will necessitate of realignment surgery in order to straighten the toe. All of these treatments involve day case surgery and a small scar of less than 1 centimeter. The recovery will depend on the type of surgery but in all cases, it is permitted to walk from day one, sometimes with the use of an orthopaedic shoe for a few weeks. 

For a personalised consultation and to explore what are the best options for you, please contact us.