Anatomy of the Foot and Toes

Nearly one-fourth of all bones in the human body are in the feet. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections, the forefoot, the midfoot and the hindfoot. The forefoot has five toes (14 phalanges) and five longer bones (metatarsals). One phalanx of each of the five toes connects to one of the five metatarsals.

The big toe, or great toe (hallux), contains two joints, the MTP and DIP. Each of the four lesser digits, or smaller toes, contains three joints. The metatarsophalangeal joint (MTP) connects the toe to the foot. The middle joint is the proximal interphalangeal joint (PIP). The small joint at the end of the toe is the distal interphalangeal joint (DIP).

Difficulties with the feet and toes can lead to more serious problems, not only for the feet, but also for other areas, including the spine. In some cases, these problems may be caused by footwear that fits improperly, does not accommodate normal foot alignment, or that interferes with natural movement and balance of the body.

What Are Hammer Toes?

Hammer toe is a bending in the toe at the PIP joint that points the joint up and prevents the toe from lying flat. In severe or advanced cases, the toe appears to be stuck in an upside-down V shape when viewed from the side. Although a mild hammer toe may not cause immediate problems, left untreated it will progress and may result in a permanently curled toe. Hammer toes are a common foot issue that usually develop in the lesser digits, most often in the second, third or fourth toe.

Flexible Hammer Toes—The joint is moveable, but a noticeable curl is beginning to form. Hammer toes are considered less serious in the developmental stage because they can be diagnosed and treated.

Rigid Hammer Toes—Waiting too long to seek professional treatment can result in tight tendons and a misaligned, immobile joint that is more likely to require surgery.

Symptoms of Hammer Toes

  • One or more toes that appear to curve, or curl, much more than the others
  • Pain at the top of the affected toe(s), especially with pressure from footwear
  • Pain on the ball of the foot
  • Pain or difficulty moving the toe
  • Formation of corns or calluses on the affected joint
  • Redness or swelling of the joint

Causes and Risk Factors

An abnormal balance of the muscles in the toes causes increased pressure on muscles, tendons and joints, which can cramp the toes and push them out of their normal position. Over a long period of time, this can lead to a tightening or contracture, and leave the toes in a fixed, curled position.

Risk factors for hammer toe include:

  • Arthritis, diabetes, or other health conditions that affect the feet and toes
  • Bunions
  • Footwear that fits poorly or forces the toes into unnatural positions
  • Heredity
  • High arches or flat feet
  • Long toes that make it difficult to find properly fitting footwear
  • Second toes that are longer than your big toes (Morton’s toe)
  • Trauma

Diagnosing Hammer Toes

During your physical examination, your specialist will check your toes and joints, and may also ask you to stand and walk with and without your shoes. You may also be asked to describe your symptoms and daily footwear. While a diagnosis can often be made during the exam, your specialist may also require diagnostic imaging studies such as X-rays or other special tests to ensure there are no nerve problems or other issues causing or contributing to the condition.

Nonsurgical Treatment

Seeking early treatment for hammer toe is critical. Unless it is treated, the condition will progress and become rigid, making nonsurgical treatments less of an option. Your physician may recommend multiple nonsurgical treatments to relieve pressure on the affected toes and allow them more room to return to their natural position.

  • Update to properly fitting footwear with a wider toe box; switch from high heels to flats
  • Add padding around the affected toe joint to minimize friction and pain
  • Tape the toes to correct the imbalance and relieve stress and pain
  • Orthotic devices or custom shoe inserts that support the foot and hold toes in the correct position
  • Toe exercises or stretches to help correct alignment
  • Pain medications, including over the counter, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen

Surgery

If the hammer toe has progressed to rigidity and nonsurgical treatments prove ineffective, your podiatric specialist may recommend surgery (arthroplasty) to reconstruct or replace the joint. For less severe deformities, the bony prominence is removed to restore normal alignment of the toe joint and relieve pain. More advanced cases may require a more complex surgical procedure to correct the deformity and straighten the toe to a normal position.

Once the alignment of the affected toe has been corrected, it is held in place with stitches (sutures) or a metal pin until it heals.

Recovery From Surgery

Following your arthroplasty, you may be fitted with a post-op shoe that has a stiff, wooden sole to protect the toe and keep the foot from bending. Bandages or dressings are worn for approximately one week, and any non-dissolvable stitches are removed in 10 to 14 days. Pins are typically left in place until the bone begins to mend, usually in about two to four weeks.

Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain can typically be managed with medications prescribed by your podiatrist.

Preventing Hammer Toe

The best way to prevent developing this painful condition is to wear comfortable, properly fitting shoes and maintain healthy foot hygiene.

  • Avoid high heels and footwear with pointed toes and tight straps
  • Choose styles that provide cushioning, flexibility, and have roomy toe boxes that allow natural toe movement
  • Use inserts or padding as needed to provide support and protect toes from pressure
  • Keep toenails properly trimmed
  • Perform toe exercises to maintain foot muscle strength
  • If you have diabetes, other risk factors for hammer toes, or experience pain or discomfort in your toes or feet, see your podiatrist regularly