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Hammer toe

Definition

Hammer toe is a deformity of the toe, in which the end of the toe is bent downward.

Causes, incidence, and risk factors

Hammer toe usually affects the second toe. However, it may also affect the other toes. The toe moves into a claw-like position.

The most common cause of hammer toe is wearing short, narrow shoes that are too tight. The toe is forced into a bent position. Muscles and tendons in the toe tighten and become shorter.

Hammer toe is more likely to occur in:

• Women who wear shoes that do not fit well or have high heels
• Children who keep wearing shoes they have outgrown

The condition may be present at birth (congenital) or develop over time.

In rare cases, all of the toes are affected. This may be caused by a problem with the nerves or spinal cord.

Symptoms

The middle joint of the toe is bent. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe.

A corn often forms on the top of the toe. A callus is found on the sole of the foot.

Walking or wearing shoes can be painful.

Signs and tests

A physical examination of the foot confirms that you have hammer toe. The health care provider may find decreased and painful movement in the toes.

Treatment

Mild hammer toe in children can be treated by manipulating and splinting the affected toe.

The following changes in footwear may help relieve symptoms:

• Wear the right size shoes or shoes with wide toe boxes for comfort, and to avoid making hammer toe worse.
• Avoid high heels as much as possible.
• Wear soft insoles to relieve pressure on the toe.
• Protect the joint that is sticking out with corn pads or felt pads

A foot doctor can make foot devices called hammer toe regulators or straighteners for you, or you can buy them at the store.

Exercises may be helpful. You can try gentle stretching exercises if the toe is not already in a fixed position. PIcking up a towel with your toes can help stretch and straighten the small muscles in the foot.

For severe hammer toe, you will need an operation to straighten the joint.

• The surgery often involves cutting or moving tendons and ligaments.
• Sometimes the bones on each side of the joint need to be connected (fussed) together.

Most of the time, you will go home on the same day as the surgery. The toe may still be stiff afterward, and it may be shorter.

Support Groups

Expectations (prognosis)

If the condition is treated early, you can often avoid surgery. Treatment will reduce pain and walking difficulty.

Complications

• Foot deformity
• Posture changes caused by difficulty in walking

Calling your health care provider

If you have hammer toe, call for an appointment with your health care provider:

• To get instructions on the best treatment
• If your pain gets worse
• If you have difficulty walking

Prevention

Avoid wearing shoes that are too short or narrow. Check children's shoe sizes often, especially during periods of fast growth.

References

Krug RJ, Lee EH, Dugan S, Mashey K. Hammer toe. In: Frontera WR, Silver JK, Rizzo TD Jr., eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 82.