A hammertoe refers to a contracture deformity of the lesser toes (2nd, 3rd, 4th, or 5th toe). The hammered or contracted appearance of the toe occurs as a result of a tendon imbalance, most frequently the tendon pulling the toe downward overpowering the internal muscle between the bones of the toes. There is usually some degree of flat foot/pronation associated, though it can be seen in a high arched foot as well. In some cases, there is a physical aspect causing hammertoes such as a bunion leaning into the space of the toes. The underlying cause is usually hereditary in nature, though poor fitting shoes and foot type (flat foot or high arched foot) are also contributing factors. Symptoms include pain or discomfort, especially while wearing tighter shoes. Rubbing and/or callous/corn formation may also occur. Long term implications involve arthritic joint changes and chronic discomfort/pain. There are 2 main types of hammertoes, which will be explained more below.
Flexible hammertoe means that the deformity of the contracted toe can be reduced by manipulation to straighten it. Typically, this indicates that the hammertoe is relatively recent. These tend to do better with conservative treatment, such as a hammer toe pad, orthotics, or simply a roomier shoe with more toe depth. If left untreated, flexible hammertoes tend to progress to rigid hammertoes.
Rigid hammertoe refers to a non-reducible deformity of the toe, and cannot be straightened by manipulation. Typically, this mean the hammertoe has been around for a longer period of time, and some more chronic arthritic changes have settled into the joints of the toes (lesser toes are made of 3 small bones). Also, there tends to be more issues with callouses/corns due to the rigid nature of this deformity. Conservative therapy can still be attempted to make the toe more comfortable, but may not be as successful compared to a flexible hammertoe.
Treatment will usually begin with conservative therapy (unless otherwise requested by the patient), with surgical options available. For more information, please feel free to get in touch with us.