Treatment - How can I help

Hammer Toe

Other Popular Names

Who Does it Affect?

Hammer Toes can affect anyone.  Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. 

Shoes that narrow toward the toe may make your forefoot look smaller. But they also push the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading to the formation of corns and calluses, which further aggravate the condition. A higher heel forces the foot down and squishes the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles become unable to straighten the toe, even when there is no confining shoe.

Symptoms

A hammer toe or contracted toe is a deformity of the proximal interphalangeal joint (PIPJ) of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer.  Mallet toe is a similar condition affecting the distal interphalangeal joint (DIPJ).  Claw toe is another similar condition, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint (MTPJ), combined with flexion of both the proximal and distal interphalangeal joints. Claw toe can affect the second, third, fourth, or fifth toes.

Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery. 

People with hammer toe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Diagnostics

The condition is readily identifiable upon examination by your Consultant.

An x-ray may be required to look at internal structures in the foot.

Non-Surgical Treatment

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than your longest toe. (Note: For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. Or, a shoe repair shop may be able to stretch the toe box so that it bulges out around the toe. Sandals may help, as long as they do not pinch or rub other areas of the foot.

Your Consultant may also prescribe some toe exercises that you can do at home to stretch and strengthen the muscles. For example, you can gently stretch the toes manually. You can use your toes to pick things up off the floor. While you watch television or read, you can put a towel flat under your feet and use your toes to crumple it.

Surgical Treatment

Having exhausted all non-surgical means, your Consultant may recommend surgery.

Usually, surgery is done as a day case.  A cut is made across the top of the hammer toe. If several toes are operated on at the same time, each toe has its own cut.  The joint in the middle of the toe is opened and some bone removed to allow correction of the deformity.  The joint at the base of the toe may also need to be freed up through a cut on top of the foot. Occasionally one of the tendons from the underside of the toe is re-routed to the top of the toe to help keep it corrected.

Post-Surgery Rehabilitation

You can go home soon after the operation.   The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The dressing on your foot can be removed two or three days after surgery and replaced with a simple adhesive dressing to cover the wound.

You will be seen again about 10-14 days after your hammer toe operation to check the wound and the toe.

Return to normal routine

You can walk on the foot immediately after surgery. The ball of the foot may be rather sore after the toe is straightened so you may wish to put most of your weight on your heel for the first week or two.

After your stitches are removed you can start taking increasing exercise. Start with walking or cycling, building up to more vigorous exercise as comfort and flexibility permit. Most people can get back to their previous level of activity within 6-8 weeks of surgery.

Return to driving:

If you have only your left foot operated on and have an automatic car you can drive within a few days of the operation, when your foot is comfortable enough. Most people prefer to wait till the stitches are removed and they can wear a shoe.

Return to work:

If your foot is comfortable, and you can keep your foot up and work with your foot in a special shoe, you can go back to work within a few days of surgery. On the other hand, in a manual job with a lot of dirt or dust around, you may need to take anything up to one months off work. How long you are off will depend on where your job fits between these two extremes.

Risks:

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).

Specific risks:

The commonest problem is that the toe can curl up again, usually to a much less severe degree then before. This occurs in about 5% of people, but only a few of these will have to have further surgery.  Most people’s toes will be fairly swollen after the operation and settles down over the next few months.

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