Hammer Toe – OrthoInfo – AAOS

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.

A hammer toe deformity of the second toe. Pressure from the patient’s shoe has caused a corn to develop on the raised portion of the toe.

The forefoot is made up of five toes. Each toe has three joints—except for the first (big) toe, which usually has only two joints.

In hammer toe, the affected toe is bent at the middle joint, which is called the proximal interphalangeal (PIP) joint.

This illustration of hammer toe shows the abnormal bend of the PIP joint.

Hammer toe is the result of a muscle imbalance that puts pressure on the toe tendons and joints. Muscles work in pairs to straighten and bend the toes. If the toe is bent in one position long enough, the muscles and joints tighten and cannot stretch out.

Wearing shoes that do not fit properly is a common cause of this imbalance. Shoes that narrow toward the toe 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. Shoes with a higher heel force the foot down and push the toes against the shoe, increasing the pressure and the bend in the toe. Eventually, the toe muscles can no longer straighten the toe.

A hammer toe is painful, especially when the patient is moving it or wearing shoes. Other symptoms may include:

• Swelling or redness
• Inability to straighten the toe
• Difficulty walking
• A corn or callus on the top of the middle joint of the toe or on the tip of the toe

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Physical Examination

Your doctor will perform a physical examination to determine if the toe joint is flexible or rigid. This information will help him or her determine the appropriate treatment.

Tests

X-rays. X-rays provide images of dense structures, such as bone. Your doctor may order an x-ray of your foot to confirm the diagnosis.

Other tests. Patients who have diabetes or decreased sensation in their feet may require further testing to determine whether a neurological condition is the cause of the tendon imbalance.

Nonsurgical Treatment

In the early stages of hammer toe—when the joint is still flexible—treatment typically consists of simple measures.

Changes in footwear. Your doctor will recommend that you avoid wearing tight, narrow, high-heeled shoes. Shoes should be one-half inch longer than your longest toe—which, for many people is the second toe—and have a soft, roomy toe box.

You may also be able to find a shoe with a deep toe box that accommodates the hammer toe. A shoe repair shop may be able to stretch a toe box so that it bulges out around the toe. Wearing sandals may help, if they do not pinch or rub other areas of the foot.

Exercises. Specific exercises can help stretch and strengthen the muscles in your foot. Your doctor may recommend gently stretching your toes manually or using your toes to pick things up off the floor. He or she may also recommend doing “towel curls” to strengthen the toes. To perform a towel curl, place a towel flat under your foot and use your toes to crumple it.

Doing “towel curls” can help strengthen the toes and restore muscle balance.

Over-the-counter remedies. Using commercially available straps, cushions or nonmedicated corn pads can help relieve pain. If you have diabetes, poor circulation, or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.

Surgical Treatment

If the toe joint is rigid and no longer moveable, or if nonsurgical treatment does not relieve your symptoms, your doctor may recommend surgery. Surgery is typically performed on an outpatient basis using a local anesthetic. The actual procedure will depend on the type and extent of the deformity.

Tendon lengthening. For patients with a flexible toe joint, the condition can often be treated by lengthening the tendons that are causing the joint imbalance.

Tendon transfer. Some patients with a flexible toe joint may benefit from treatment that involves transferring tendons from the bottom of the toe to the top of the toe to help pull the joint into a straight position. 

Arthrodesis (joint fusion). Patients who have a rigid toe joint may undergo tendon lengthening in combination with arthrodesis. In this procedure, your doctor will remove a small part of a bone in the toe joint to ensure that the toe can extend fully. He or she will then insert an external wire or pin and/or internal plate to hold the bones in place while the bones fuse together.

A) A hammer toe. B) In arthrodesis, a small amount of bone is first removed from the PIP joint. C) Here, a metal pin has been inserted to hold the bones in place until they fuse.

This patient’s three hammer toes have been corrected with arthrodesis. A metal pin has been inserted in each toe to hold the bones in place while they fuse. Plastic caps have been placed over the tips of the pins.

After surgery, you may experience some stiffness, swelling and redness in your toe for up to 4-6 weeks. Although you will be able to put pressure on the foot immediately after surgery, you should try to limit your activity while the toe heals. Elevating your foot as much as possible will help speed up healing and reduce pain. Once healed, your toe may be slightly longer or shorter than it was before.

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4 Ways to Reverse Hammertoe Without Surgery

4 Ways to Reverse Hammertoe Without Surgery

By: admin | Tags: hammertoe causes, hammertoe treatment, hammertoes, nonsurgical treatments | Comments:
0 | April 23rd, 2015

Hammertoes, perhaps better described as “curled” or “bent” toes, are a widespread cause of foot discomfort and a common source of insecurity about foot appearance. A hammertoe gets its name from the way it looks from the side – with a fixed bend in one or both of the toe’s joints, it creates a shape that looks like the head of a hammer. Fortunately, many cases of hammertoes can be improved, if not completely reversed, through nonsurgical measures. Here’s an overview of what causes hammertoe and how the condition can be treated without surgery.

What causes hammertoe?

Hammertoe typically affects the second, third or fourth toes and is caused by repeated constriction, often when the toes are forced into a bent position for long periods of time. This constriction results in a muscle imbalance, causing the toe to assume a curled or bent position. Though you may not realize it, there are six sets of muscles that help to stabilize the bones of your second through fifth toes. Each of these muscles works to keep the toes flat on the ground when you’re walking. When the muscle balance is thrown off, it can lead to bucking and contracting of the toe joint.

A majority of hammertoe cases result from wearing uncomfortable shoes, particularly shoes that are narrow, tight or pointy toed – all of which can bind the forefoot. Other risk factors include foot anatomy and prior toe injuries. For instance, if you have a bunion or a second toe that’s longer than your big toe, you are more likely to develop this condition.

How do you reverse hammertoe?

In many cases, hammertoe can be successfully treated without surgery if it’s tended to in its early stages while the affected toe is still flexible. Because of this, it is important that you seek treatment at the earliest sign of a developing hammertoe in order to ensure the best outcome. Since hammertoe is a progressive condition that gets worse over time, the earlier you seek treatment, the better.

What are the nonsurgical treatments for hammertoe?

At NY-based foot and ankle center, Extend Orthopedics, Stuart Katchis, M. D. has successfully treated many patients suffering from painful and embarrassing hammertoes without the need for surgery. Here are four conservative treatment options that have shown successful outcomes for early stage cases.

1. Physical therapy – Stretching and strengthening exercises can be a great first line of defense to help reverse the muscle imbalance that causes a hammertoe.
2. Footwear modifications – Any shoes that force one or more toes into a bent position must be avoided. This includes tight, narrow shoes and most high heels. Instead, shoes with roomy toe boxes that comfortably fit all 5 toes without overcrowding should be worn.
3. Use of orthotics – In addition to stretching and strengthening exercises, orthotic devices can be useful for counteracting muscle imbalances (and preventing future ones from occurring) by repositioning the foot and toes while wearing shoes.
4. Splinting – Applying splints or tape to the affected toe can help realign it and prevent further bending.

What if conservative treatments don’t work?

In some cases, nonsurgical treatments may not work – especially for more severe cases of hammertoe where the affected toe is no longer flexible. If symptoms do not improve after pursuing conservative treatment options, Dr. Katchis may recommend a surgical treatment. Fortunately, our practice offers a cutting edge hammertoe correction procedure called Nextradesis, which uses a proprietary implant device that allows patients to bear weight on the affected foot immediately after surgery. It also results in a much faster recovery for patients than traditional hammertoe surgery and it minimizes any chance of recurrence.

Hammertoe Treatment in NYC

If you are seeking treatment for a hammertoe in the NYC area, schedule a consultation at Extend Orthopedics today. We offer two convenient locations in Manhattan and Westchester County. Call our office at (212) 434-4920 or fill out the form on this page to get started. Remember: the earlier you get treated, the more likely that you can effectively eliminate your symptoms without surgery!

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• General information

  Hammer toe deformity is an acquired anomaly of their structure. This phenomenon occurs if you often wear tight shoes with a narrow toe or walk in high heels. The extreme phalanges of 2 or 3 fingers are wrapped down, and their middle part rises. As a result, when walking, a person begins to knock on the ground with his fingers, like a hammer, hence the name of the deformation.

  The operation is indicated if the conservative treatment of the hammer toe does not work, as well as when the quality of life worsens in the process of rapid progression. There are several ways of surgical intervention to correct the hammer-shaped form of the phalanges. After a thorough diagnosis, the surgeon chooses the method of surgical intervention:

  Resection of the metatarsal head that protrudes excessively outward. It is carried out with minor bone changes, as well as with developing bursitis. The mucous bag is also removed and the plastic of the joint capsule is performed.

  Displacement of the proximal phalanx of the first finger. With such an operation, metatarsal plastic surgery is often performed to ensure the normal position of the second finger and others.

  Proximal or distal osteotomy – the technique is used for large-scale deformities, during the operation structures are placed to strengthen the joint.

  Removal of the bone process – is carried out in the presence of an overgrown callus, which brings pain to the patient during movement, worsens the quality of life.

  Rehabilitation period:
  After the operation, patients stay for some time in a day hospital, usually not longer than a day, if there are no complications. The sutures are removed after two weeks. If wire structures were installed for fixation, they can be preserved up to one month of treatment. The first two months after the treatment of hammertoe deformity, the foot is partially loaded, dosed. It is necessary to use special shoes that relieve the load from the forefoot. The maximum time to use corrective shoes is six months.

• Aganesov Alexander Georgievich

  Surgeon

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“Big problems of small damage” – this phrase is used by many surgeons to characterize the treatment of injuries of the extensor tendon of the finger at the level of the interphalangeal joint. Despite significant progress in hand surgery, the treatment of this type of injury remains difficult. Meanwhile, it is not uncommon: 1.5-3% of all hand injuries. These, at first glance, small percentages indicate a huge number of patients, since the hand is the most frequently injured part of the human body.

As a result of tendon rupture, the terminal phalanx ceases to actively extend, and the finger looks like a hammer (Fig. 1). The second name for this injury is “falling finger”. Due to the fact that this injury often occurs during sports, it is sometimes called “baseball player’s or basketball player’s finger.”

This injury occurs more frequently in men than in women. Interestingly, men with this pathology are about 10 years younger than female patients.

More often than others, the middle finger is damaged, then the ring finger, index finger, little finger, and less often the big one.

Most often “hammer deformity” occurs as a result of a direct blow to the tip of an extended finger, and in some cases as a result of a small external force, including the performance of everyday harmless routines: dress, undress, make the bed, fasten buttons. The most common mechanism of closed injury is severe flexion of the terminal phalanx while the finger is actively held in extension: hitting the fingertip of a basketball or volleyball, hitting the floor with a finger, pulling the toe with a straightened finger, trying to tuck a blanket or bedspread with straight fingers. In some patients, the deformity occurs without visible injury.

Immediately after an injury, patients are concerned about pain in the joint. Externally, the finger becomes unattractive. Within a few weeks, the pain decreases, but functional disorders persist without treatment. “Hammer-shaped deformation” makes it difficult to hold small objects, put on gloves. The “humped finger” constantly bumps into protruding objects, which can increase pain and increase deformity.

With a rupture of the tendon mechanism at the level of the terminal phalanx, the extension force is concentrated on the middle phalanx. Over time, this often leads to hyperextension of the middle phalanx and the appearance of a swan neck deformity of the finger.