Hammer toes are deformities in the toes where one or more toes become bent at the middle joint, resembling a hammer. They typically affect the second, third, or fourth toes. Hammertoes can range in severity from flexible, where the toe can still be straightened, to rigid, where the toe is fixed in the curled position. Several factors can contribute to the development of hammer toes:
Muscle Imbalance:
Imbalance between the muscles, tendons, and ligaments that normally hold the toe straight can cause it to bend. There are three theories of muscular imbalance: flexor stabilization, flexor substitution and extensor substitution.
Flexor Stabilization:
Mechanism: This is considered the most common cause of hammertoe. It occurs when the long flexor muscles, responsible for bending the toes downwards, overpower the interosseous muscles, which are smaller muscles that help stabilize and extend the toes. This imbalance often results from excessive pronation, where the foot rolls inward excessively. This pronation destabilizes the forefoot, causing the flexor muscles to fire earlier and with more force, leading to a curled toe position.
Extensor Substitution:
Mechanism: This theory suggests that the long extensor muscles, which lift the toes, become overactive in an attempt to compensate for weakness in the tibialis anterior muscle (a muscle on the front of the shin that helps lift the foot). When the tibialis anterior is weak, the long extensors contract more forcefully to help clear the foot during the swing phase of walking. This can lead to hyperextension of the metatarsophalangeal joint (the joint where the toe connects to the foot) and flexion of the proximal interphalangeal joint (the middle toe joint), resulting in a hammertoe deformity.
Flexor Substitution:
Mechanism: This is the least common of the three theories. Here, the flexor digitorum longus (a flexor muscle in the lower leg) overpowers the lumbricals and interossei (small muscles in the foot) in an attempt to assist with plantarflexion (pointing the foot downwards). This can occur if the calf muscles are weak. The imbalance leads to a downward pull on the toe, resulting in a hammertoe deformity.
Over time, the bent position becomes rigid.
Genetics:
Some people inherit a tendency to develop hammer toes due to the shape and mechanics of their feet (e.g., flat feet or high arches).
Trauma or Injury:
Stubbing, jamming, or breaking a toe can lead to hammer toe deformities if it heals in the incorrect position.
Certain Medical conditions:
Arthritis, especially rheumatoid arthritis, can affect joints and lead to deformities. Diabetes and neuromuscular disorders like Charcot-Marie-Tooth disease, for example, can impair muscle function and balance and contribute to the formation of hammertoes.
Arthritis, especially rheumatoid arthritis, can affect joints and lead to deformities. Diabetes and neuromuscular disorders like Charcot-Marie-Tooth disease for example can impair muscle function and balance and contribute to the formation of hammertoes.
Poor Footwear:
High heels and tight or narrow shoes force the toes into a bent position, especially if worn frequently. Shoes that are too short can crowd the toes, pushing them into unnatural positions.
Treatment
Treatment for hammer toes depends on the severity (flexible vs. rigid) and how early it’s addressed.
Non-surgical treatments:
Proper Footwear: Wear wide-toed shoes with low heels and soft uppers. Avoid tight, narrow, or high-heeled shoes that cramp your toes.
Toe spacers or orthotics: Use gel toe caps, corn pads, or toe spacers to relieve pressure and prevent friction. Custom orthotic inserts can help correct underlying structural imbalances.
Splinting or taping: For flexible hammer toes, splints or tape can help realign the toe temporarily and reduce strain.
Pain Relief: Over-the-counter NSAIDs like ibuprofen can reduce inflammation and pain. Ice packs may help if there’s swelling.
When surgery might be needed
If the hammer toe becomes rigid and painful, or doesn’t respond to conservative care. Common procedures include tendon lengthening, joint release, or joint fusion.
Come see us at District Foot & Ankle for a proper evaluation and diagnosis so we can get you back to being a better you today!