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A hammertoe is a deformity in the foot, causing the second, third, or fourth toe to be permanently bent in the middle joint, causing the toe to resemble a hammer (hence, its name!) or a claw. They are most commonly found in women who wear narrow shoes, such as high heels, that cause the toes to bend unnaturally for extended periods of time. A hammertoe may be difficult or painful to move, and the skin may become callused from rubbing against the inside of the shoe. In fact, there are two types of hammertoe: flexible and rigid. Flexible hammertoes can still move at the joint and are indicative of an earlier, milder form of the problem. Rigid hammertoes occur when the tendon no longer moves, and at this stage, surgery is usually necessary to fix the problem.

Wearing ill fitting shoes is probably the main cause of hammer toe. As the toe bends, tendons add to the problem by contracting in such a way that the bending is reinforced to the point of becoming permanent. In some cases, tendons that are abnormal to begin with may start the bending process.

The most common symptoms of hammertoes include. The toe is bent upward at the middle toe joint, so that the top of this joint rubs against the top of the shoe. The remainder of the toe is bent downward. Pain upon pressure hammertoe at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe. This occurs because the contracted digit puts pressure on the metatarsal head creating callouse and pressure on the ball of the foot.

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X ray the affected area and recommend a treatment plan specific to your condition.

The technique the surgeon applies during the surgery depends on how much flexibility the person’s affected toes still retain. If some flexibility has still been preserved in their affected toes, the hammer toes might be corrected through making a small incision into the toe so the surgeon can manipulate the tendon that is forcing the person’s toes into a curved position. If,
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however, the person’s toes have become completely rigid, the surgeon might have to do more than re aligning the person’s tendons. Some pieces of bone may have to be removed so the person’s toe has the ability to straighten out. If this is the case, some pins are attached onto the person’s foot afterwards to fix their bones into place while the injured tissue heals. Following the surgical procedure, the person might have to deal with some stiffness and swelling as they pursue their recovery process. The person should also expect the toes that have been corrected to appear different following the surgery. For example; the person’s toes may appear longer or shorter than they were before. The person will be advised not to pursue too much physical activity that involves their feet for some time to give their injury from surgery enough time to heal properly.

Wide toe box, bunion pads, orthotics, or a combination. Mild discomfort may lessen by wearing a shoe with a wide toe box or with stretchable material. If not, bunion pads purchased in most pharmacies can shield the painful area. Orthotics can also be prescribed to redistribute and relieve pressure from the affected articulation. If conservative therapy fails, surgery aimed at correcting abnormal bony alignments and restoring joint mobility should be considered. If the patient is unwilling to wear large, wider shoes to accommodate the bunion because they are unattractive, surgery can be considered; however, patients should be told that orthotic devices should be worn after surgery to reduce the risk of recurrence. For bursitis, bursal aspiration and injection of a corticosteroid are indicated. For osteoarthritic synovitis, oral NSAIDs or an intra articular injection of a corticosteroid/anesthetic solution reduces symptoms. For hallux limitus or hallux rigidus, treatment aims to preserve joint mobility by using passive stretching exercises, which occasionally require injection of a local anesthetic to relieve muscle spasm. Sometimes surgical release of contractures is necessary.

Bunion surgery is most often a day case or one night in hospital. Surgery can be done under ankle block (patient awake) or general anaesthetic. It is best to rest with the foot elevated for the first 2 weeks after surgery. The foot is bandaged and a special sandal supplied by the hospital is worn for 6 weeks. Sensible shoes are to be worn for a further 6 weeks after the bandages are removed. It will take between 3 6 months for the swelling to go down. It will take 12 months before everything completely settles. It is also important to remember that not all bunion operations are entirely successful.
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