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Hammer toes: Causes, symptoms, treatment and prevention

What are hammer toes?

Hammer toes are common and painful deformities in the three middle toes where they appear to always be bent.

Causes of hammer toes include shoes that don’t fit properly, foot injuries, bunions, and rheumatoid arthritis.

Having toe joints sticking out can cause them to rub and a person may walk differently, risking other foot conditions, such as metatarsalgia.

Hammer toes can be a serious problem in people with diabetes or poor circulation.

Photo of side view of hammer toes

There are two types of hammer toes:

  • Flexible hammer toes. If the toe can still be moved at the joint, it's a flexible hammer toe. That's good, because this is an earlier, less-severe form of the problem. There may be several treatment options.
  • Rigid hammer toes. If the tendons in the toe become rigid, they press the joint out of alignment. At this stage, the toe can't be moved. This usually means surgery is required to correct the problem.

What causes hammer toes?

The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammer toe can form. Muscle imbalance puts a lot of pressure on the toe's tendons and joints. This pressure forces the toe into a hammerhead shape.

How do the toe muscles get out of balance? There are three main reasons:

  • Your genes: you may have inherited a tendency to develop hammer toes because your foot is slightly unstable - such as a flat foot. But high-arched feet can also get hammer toes.
  • Arthritis
  • Injury to the toe: ill-fitting shoes are the main culprits of this cause. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes.

What are the symptoms of hammer toes?

A toe stuck in an upside-down "V" is probably a hammertoe. Some symptoms are:

  • Pain at the top of the bent toe when putting on a shoe
  • Corns forming on the top of the toe joint
  • The toe joint swelling and taking on an angry red colour
  • Difficulty in moving the toe joint - and pain when you try to
  • Pain on the ball of the foot under the bent toe

Seek medical advice if:

If your feet regularly hurt, you should see a doctor or podiatrist. If you have a hammertoe, you probably need medical attention. Ask your doctor for a referral to a podiatrist or foot surgeon. Act now, before the problem gets worse.

How do I know if I have hammer toes?

A thorough medical examination will tell whether you have a hammer toe. Usually an X-ray is part of this examination to assess the extent of the condition.

What are the treatments for hammer toes?

You should seek medical advice if you have a hammer toe. Here are some things you can do in the meantime. None of these things will cure the hammer toe, but they may relieve the pain and discomfort:

  • Only wear shoes that are high and broad across the toes. There should be at least 1.5 cm of space between your longest toe and the tip of the shoe. Keep in mind that this could be either your big toe or your second toe.
  • Don't wear heels higher than 5 cm.
  • Wear the appropriate shoe for the activity you are doing.
  • You can buy non-medicated hammer toe pads. They fit around the pointy top of the toe joint and help relieve painful pressure.
  • Gently massaging the toe may help relieve pain.
  • Put ice packs wrapped in cloth on the hammer toe to reduce painful swelling.

There are several treatment options. These are based on how severe the problem has become. The sooner a person seeks treatment, the more options that person may have.

  • Wear properly fitting shoes - this does not necessarily mean expensive shoes.
  • Padding any prominent areas around the bony point of the toe may help to relieve pain.
  • Medication that reduces inflammation can ease the pain and swelling.
  • Sometimes a doctor will use cortisone injections to relieve acute pain.
  • A podiatrist may also custom-make an insert to wear inside your shoe. This can reduce pain and keep the hammer toe from getting worse.
  • Your doctor may recommend foot exercises to help restore muscle balance. Splinting the toe may help in the very early stages.
  • There are several surgical techniques used to treat hammertoes.
  • When the problem is less severe, the doctor will remove a small piece of bone at the involved joint and realign the toe joint. More severe hammer toes may need more complicated surgery.

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