most commonly affects the second toe on the foot. It
causes the middle joint to bend. Hammertoe is most frequently caused by structural problems in the toe or from Hammer toe
wearing poor fitting shoes. It is important to diagnose and
treat hammertoe early because the condition tends to become worse over time. If left untreated, hammertoe can require surgery.
The APMA says that hammertoe can result from a muscle imbalance in the foot that puts undue pressure on the joints, ultimately causing deformity. Inherited factors can contribute to the likelihood of
developing hammertoe. Arthritis, stroke or nerve damage from diabetes or toe injuries such as jamming or breaking a toe can affect muscle balance in the foot, leading to hammertoe. The Mayo Clinic
says that wearing improper shoes often causes hammertoe. Shoes that squeeze the toes, such as those with a tight toe box or with heels higher than two inches, can put too much pressure on the toe
Symptoms of a hammertoe are usually first noticed as a corn on the top of the toe or at the tip which produces pain with walking or wearing tight shoes. Most people feel a corn is due to a skin
problem on their toes, which in fact, it is protecting the underlying bone deformity. A corn on the toe is sometimes referred to as a heloma dura or heloma durum, meaning hard corn. This is most
common at the level of the affected joint due to continuous friction of the deformity against your shoes.
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear
crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at
the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still
flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the
involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. In addition, she may choose to treat the pain that may result
from the condition. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options
for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. Splinting devices come in a variety of shapes and sizes but the
purpose of each is the same: to stretch the muscles and tendon and flatten the joint to remove the pain and pressure that comes from corns.
Surgery to straighten the toe may be needed if an ulcer has formed on either the end or the top surface of the toe. Surgery sometimes involves cutting the tendons that support movement in the toe so
that the toe can be straightened. Cutting the tendons, however, takes away the ability to bend the very end of the toe. Another type of surgery combines temporary insertion of a pin or rod into the
toe and alteration or repair of the tendons, so that the toe is straightened. After surgery, the deformity rarely recurs.