Hammer toe: common causes and prevention

Hammer toe is a deformity of the toe that usually affects the second toe as it is comparatively longer in size. However, it can also affect all the middle three digits though it does not affect the big toe.

Hammer toe is best described as a “contraction of the PIP or the middle joint” resulting in severe pain at the top of the toe caused mainly by the constant pressure of a tight fitting shoe.

Causes of hammer toe

Various surveys have highlighted the fact that the incidence of hammer toe ranges from 2% to 20% and in most cases, it usually affects women. Hammer toe is primarily caused due to wearing tight fitting shoes over a number of years. The hard rub of the toes against the sides of the shoes results in corns or calluses. The corn appears on the top, while the callus forms on the sole of the foot. The result is that the toe becomes bent or buckled and appears like a hammer. In fact, the walking posture, too, may change due to the constant pain.

Tight fitting, and more especially the narrow, pointing and lace-up shoes, tend to bend the second and the third toes due to what can be termed as ‘repetitive over crowding’. If the tight fitting shoes are also high heeled, they only serve to make matters worse. This is because most of the load of the foot is transferred to the forefoot and this pushes the toes against the narrow end of the shoes. The toe muscles contract and cannot straighten. Some experts say that should at least be half an inch inch space for the longer toes to remain flexible.

Though the primary cause for hammer toe is the use of tight-fitting shoes, in some cases it can occur due to congenital and other factors such as rheumatoid arthritis and diabetes

Types of hammer toe deformities

Hammer toe deformities are of two types, flexible hammer toe and rigid hammer toe. As the names themselves suggest, flexible hammer toe allows some degree of mobility, but in case of rigid hammer toe, there can be only limited movement and that too accompanied by severe pain.

Prevention of hammer toe

According to some experts, footwear has a large role to play in the management of the digital deformities. Shoes, therefore, should be designed with a high and wide toe box and soft leather uppers to avoid direct pressure upon the toes and at the same time they should allow enough space for their movement.

Get your hammer toe examined by a podiatrist who, even upon external examination, may prescribe certain toe exercises to stretch and strengthen the muscles. You can even stretch your muscles manually by trying to pick up articles from the floor or crumpling a flat towel using your hammer toes. It may, however, be noted that forcible stretching or manipulation of toes muscles should be avoided as ligaments and tendons may be damaged.

If unfortunately the hammer toe problem remains unattended, it may become taut and cause constant pain leaving surgery as the only alternative. Usually surgery is performed using local anesthesia and does not take long and you can be discharged soon afterwards. The actual procedure and the time taken for surgery depend on the severity of the case.