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Hammer Toes

A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. 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 a hammer toe may have a corn or callus on the top of the middle joint of the toe or on the tip of the toe. There may also be pain in the toes or feet. This may lead to difficulty finding comfortable shoes.

Causes

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 the forefoot look smaller. However, 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 squashes 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.

Treatment

Patients who have diabetes, poor circulation or a lack of feeling in the feet should talk to their doctor before attempting any self-treatment.

Conservative treatment starts with new shoes that have soft, roomy toe boxes. Shoes should be one-half inch longer than the longest toe. (Note: For many people, the second toe is longer than the big toe.) Avoid wearing tight, narrow, high-heeled shoes. It may also be possible to find a shoe with a deep toe box that accommodates the hammer toe. Alternatively, a shoe repairer 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.

The surgeon may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles.

  • Gentle manual stretching of the toes
  • Using the toes to pick things up off the floor
  • Placing a towel flat under the feet and use the toes to crumple the towel. This can be done while watching television or reading.

Finally, the surgeon may recommend the use of commercially available straps, cushions or non-medicated corn pads to relieve symptoms.

Hammer toe can be corrected by surgery if conservative measures fail.