What Are Hammertoes?

Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes.

This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
The most common cause of hammertoes is a muscle/tendon imbalance. This imbalance, which leads to a bends of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.
Hammertoes may be aggravated by shoes that don't fit properly. A hammertoe may result is a toe is too long and forced into a cramped position when a tight shoe is worn.
Occasionally, hammertoes are the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
Common symptoms of hammertoes include:

• Pain or irritation of the affected toe when wearing shoes.
• Corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
• Inflammation, redness, or a burning sensation.
• Contracture of the toe.
• In more severe cases of hammertoe, open sores may form.

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
Hammertoes are progressive- they don't go away by themselves and usually they will get worse over time. However, not all cases are alike- some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:

• Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over the counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.
• Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels- conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
• Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. 
• Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoes.
• Medications. Oral nonsteriodal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe. 

In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed.
Often patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination or procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
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What's That Bump on My Big Toe?

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe. 

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and

friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult- all contributing to chronic pain. Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries. 

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second, to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

• The use of protective padding, often made from felt material, to eliminate the friction against
  
  shoes and help alleviate inflammation and skin problems. 
• Removal of corns and calluses on the foot.
• Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth. 
• Orthotic devices- both over-the-counter and custom made- to help stabilize the joint and place the foot in the correct position for walking and standing. 
• Exercises to maintain joint mobility and prevent stiffness or arthritis. 
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable. 

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe. 

Ayman M. Latif, DPM

Connecticut Foot Care Centers

Foot Deformity Doctor in Glastonbury, CT

Podiatrist in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter. 

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