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Hammer Toes

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What are hammer toes?
Causes
Symptoms
Diagnosis
Risk factors
Treatment
Prevention
FAQs

Noticing your toes curling and changing shape can become a real problem - whether the changes are causing you pain and discomfort when wearing shoes, or you’re not keen to have your toes displayed for all to see during the warmer months. Either way, you’re in the right place with our experienced Brisbane podiatrists.

What Are Hammer Toes?

Hammer toes are a type of lesser toe deformity, affecting the normal alignment of the toes other than your big toe, which puts you at risk of pains and other problems. Each of the lesser toes contain three bones (phalanges) connected to one another and to the ball of the foot by joint capsules. There are also many muscles, ligaments and tissues that attach to the toes and contribute to both their function (like when you curl your toes downwards or point your toes upwards), as well the healthy movement of the foot as a whole.

A hammer toe appears like an upside down ‘V’ shape in the affected toe(s), presenting when the toe bone closest to the ball of the foot extends upwards, and the middle bone points back downwards, with the last toe maintaining a relatively neutral position, as illustrated here. Hammertoes often affect the second toe and can occur alongside bunions.

What Causes Hammer Toes?

Hammer toes are not something you are born with, but instead develop over time. The most common causes or contributing factors to hammer toes include:

• Ill-fitting shoes (often narrow or high-heeled) that put pressure on the joints and hold them in an altered alignment
  
• Trauma (injury) to the toes
  
• Nerve damage
  
• Problems with the big toe like a bunion
  
• Instability at the joints at the ball of the foot
  
• Having a longer second or third toe
  
• Having inflammatory arthritis, synovitis, diabetes or musculoskeletal disorders have also been implicated in the development of hammer toes
  

A person may also have a greater genetic predisposition to developing hammer toes through certain structural and functional foot characteristics being passed down through families.

What Are The Symptoms Of Hammer Toes?

The biggest symptom of a hammer toe is the hammer-like position the toe is left in. This may start off as flexible, meaning that the toe can be straightened by hand, but can grow to become rigid over time. While the changes to the joints of a hammer toe may not necessarily be painful in and of their own, they can be disruptive to a person’s gait through the changes in foot biomechanics, can make it difficult to wear shoes comfortably or even find shoes that fit the forefoot, and can result in corns, calluses or blisters developing on the toes that can cause much pain and discomfort if special care is not taken. 

Hammer Toes Diagnosis

Our podiatrists can clearly and confidently diagnose a hammer toe deformity from a physical examination in our clinic. From here, we’ll be able to discuss your symptoms, treatment options and prognosis.

What Are The Risk Factors Of Leaving Hammer Toes Untreated?

When hammer toes are left untreated, they may lead to pain and discomfort when walking or wearing shoes, the development of corns, calluses, blisters and other pains - and even balance issues if multiple toes are severely affected. As hammer toes tend to progressively worsen, it is likely that your hammer toes will continue to worsen over time and grow stiffer, which can cause additional pains.

Hammer Toes Treatment Options

Managing your hammer toes starts with a podiatric exam to assess the position, integrity, flexibility and strength of the toes, joints and muscles. From here, we’ll discuss the likely causes of the changes you’re experiencing in your toes, and discuss the most suitable treatment options that will support you in getting the best outcome, whether that is helping slow or stop the progression of the deformity or manage any associated pains and problems. This may include:

• Toe props and padding: toe props and padding can help to hold the toes in a more comfortable position and reduce the incidence of rubbing and friction both against the neighbouring toes and against the shoes and the ground. This can help relieve pain and improve your comfort
  
• Foot mobilisation therapy to release the joints and the soft tissue around the joints. There are some case studies with radiographic evidence of joint alignment improving
  
• New footwear recommendations: it can be hard to know which shoes are the best for your feet - and your foot type and arch characteristics play an important role in determining this. We assess your foot posture and give you personalised recommendations for footwear that will put your foot health first, slow the progression of any existing toe deformities, and help minimise the incidence of toe pain and problems related to the toe deformities
  
• Corn and callus care: if the position of your toes is causing painful corns or calluses, we can help you manage your pain and help you walk more comfortably by debriding the calluses and removing any corns
  
• Stretching: where your hammer toes still remain flexible, we may recommend some stretching exercise that target the muscles and tendons pulling on the toes
  
• Custom foot orthotics: foot orthotics are custom devices that replace the inner liner of your shoe. In this case, we can design them to help control any muscle and tendon imbalances or instabilities that contribute to the deformities. This will help to alleviate your pain and slow the progression of the deformities, while giving your foot the best support and control. 
  

While most hammer toe deformities don’t require surgery, if your toes are fixed in place and are causing you considerable pain or discomfort, we may discuss whether a referral to an orthopedic surgeon is right for you so you can discuss your surgical options.

Is There Anything I Can Do To Prevent Hammer Toes At Home?

If you’ve just noticed changes to the position of the joints in your feet, the first thing to review is your footwear as this plays a large role in hammer toe development for many people, especially if your shoes feel tight, have a narrow forefoot, or are high-heeled. Knowing that these shoes are likely contributing to the problem, the best thing you can do is switch to shoes that have a spacious toe box, do not exceed a heel height of 40mm, and do not feel tight, even with thick socks for the cooler months. The earlier you can make these footwear changes, the better. 

If your joints still have good flexibility, you can try exercises to support the strength and flexibility of the toes. This includes gently straightening the toes to bring them into a natural position and holding for several seconds, feeling a long, slow and gentle pull. You can also try towel curls, where you use your toes to crumple a towel that is placed flat beneath your feet, and use your feet to pick up marbles on the floor and drop them into a cup.

FAQs

Is hammer toe a form of arthritis?

No hammer toes are not a form of arthritis, but a person who has inflammatory arthritis such as rheumatoid arthritis may be more prone to developing hammer toes.

Can a podiatrist fix a hammer toe?

There is a lot that podiatrists can do to help manage your pain and discomfort, and control the other symptoms of hammer toes, helping to stop or slow their progression. Given the nature of hammer toes, however, if ‘fixing’ a hammer toe means achieving a straight toe position, then any medical professional will be limited in their options aside from surgery.

What kind of shoes are best for hammer toes?

Choose shoes that are comfortable and supportive:

• Spacious toe box: look for shoes that have a spacious or wider toe box, which will allow your toes to spread out and move freely without being cramped or compressed. Avoid shoes that are too narrow, pointed or otherwise constricting.
  
• Low heel: opt for shoes with a low heel or no heel at all, as high heels can put additional pressure on the toes and exacerbate hammer toe symptoms.
  
• Arch support: choose shoes with good arch support to best help support your foot posture and redistribute any additional strain on your forefoot.
  
• Cushioning: look for shoes with ample cushioning in the insole and outsole to provide shock absorption and reduce impact on the feet.
  
• Adjustable straps: Shoes with adjustable straps or laces can help you customise the fit and prevent your foot from slipping or sliding around inside the shoe.