Hammertoe is a condition of buckling of the second, third, fourth, or fifth toe that causes the tip of the toe to bend down while the middle rises up, causing the toe to take on the shape of a hammer. Hammertoe is caused by weakened toe muscles, foot and ankle misalignment due to over-pronation, and by nerve damage related to stroke, rheumatoid arthritis, or other connective tissue disorders. Involvement of the feet is very common in rheumatoid arthritis and related disorders. Pes planus, hammertoe deformities, bunion formation, and collapse of the midfoot are considered complications of severe foot and ankle disease.
Symptoms
Hammertoes vary in shape and size but they generally cause the affected toe to take on a claw-like appearance. Usually, the second toe is most likely to be affected and it’s not unusual for more than one toe on a foot to be affected with hammertoe. Hammertoe generally results in a fixed position or deformity that can cause significant pain and discomfort with tight shoes.
The name hammertoe stems from the way the toe hits or hammers on the floor with each step. The major deformity in hammertoe is found at the proximal interphalangeal joint, which is the first or more proximal of the two joints of the toe. When the outer or distal joint is affected, the condition is known as mallet toe. When both joints are affected, the condition is known as claw toe. Collectively, mallet toe, claw toe, and hammertoe are commonly referred to as conditions of hammertoe.
Causes
Hammertoes are not caused by ill-fitting shoes or sustained wearing of high heels. Hammer toes form when there is an imbalance in the tendons that move the toe. The primary causes of hammertoe are extensor substitution and flexor substitution.
Hammertoe can be triggered by trauma, rheumatoid arthritis and related spondyloarthropathies such as ankylosing spondylitis, psoriatic arthritis, gout, septic arthritis, and systemic lupus erythematosus.
Treatment
Podiatrists, which are doctors specializing in the care of the feet are experts in the treatment of hammertoe. If the toe remains flexible, splints or special tape may help extend and flatten the toe. If the toe is rigid, surgery can straighten the toe by releasing soft tissue and repositioning tissue and bone.
Surgery varies from simple release of the extensor tendon at the top of the toe to complex tendon transfers and bone fusions. The most common surgical procedure for hammertoe was first described by Post in 1895 and is called the Post arthroplasty or Post procedure. This procedure, which can be performed under local or general anesthesia, involves resecting the knuckle of the toe at the level of the proximal joint and releasing the tendon on the top extensor surface of the foot. This causes to the toe to lay flatter and minimizes direct pressure caused by shoes.
Hammertoe can also be aided by wearing shoes with more toe space and by using non-medicated corn pads to relieve pain or pressure. Stretches also help and can be done by placing corks or foam separators between the toes and squeezing for 5-10 seconds, performing 10 repetitions. Another exercises involves stretching a thick rubber band around all five toes and stretching the band as wide as possible by flexing the toes outward. Repeat on each foot 10 times.
Resources:
Jennifer Pirtle, Feet First, Natural Health, July/August 2007.
Eleanor Williams and Kenneth Fye, Rheumatoid Arthritis, Postgraduate Medicine, November, 2003.
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