What are Hammertoes?

   

Hammertoes are an arthritic condition of the feet.   Shoes that are too narrow or too shallow will contribute to the formation of this deformity.  What most people do not know is that the foot structure will also contribute to hammertoe formation.  People with very high arches will tend to develop hammertoes because the toes begin to ride up on the metatarsal bones which are the bones just behind the toes. 

Additionally, people whose feet are very flat will also tend to develop hammertoes because of a weakness that develops in the foot musculature from the feet constantly flattening out when they walk.  Once the toes become crooked, they become difficult to fit in conventional shoes (the square peg in the round hole idea).  They even become more difficult to fit into a high style women’s dress shoe.  But because society dictates it many people, particularly women, will continue to “stuff” their feet into them. 

What then occurs is that the hammertoe deformities become more pronounced and more painful.  As Podiatrists, we make a distinction between flexible hammertoes, which are basically crooked toes that can be pulled straight, (even though they will not stay that way).  And rigid hammertoes that are bent in the crooked position and will not straighten out. 

When hammertoes are forced into shoes on a regular basis, the shoe begins to rub on the body prominences of the toes.  Anytime there is constant pressure on a bone, the bone to hypertrophy or enlarge.  This further creates more friction between bone and shoe. 

This added friction will then cause a number of things to occur.  The most common of which is the formation of a corn, or hard skin overlying the part of the toe that is constantly hitting the shoes.  This corn can be on top of the toe, on either side of the toe, or at the end of the toe, depending on the degree of deformity.  Keep in mind, that corns are formed by the body to protect the area from friction so in a sense they are a good thing.  The problem arises is when they begin to hurt. 

Along with the formation of Corns, the constant pressure will also cause the toe to become red and swollen in that area and very painful to touch.  This is usually indicative of bursitis formation. 

If the hammertoe is rigid, tendons on top of the toe may also become inflamed, plus because the hammertoe puts so much retrograde or backward pressure on the metatarsal bones, it can also cause pain on the ball of the foot. 

Treatment

Treatment should be to remove the friction or pressure on the toes which would be to change your shoe style into something more conservative, for example a boxier, wider heel. Maybe a slight modification of your shoe gear may help.  It is recommended to not use medicated corn pads because the medication in them contain acid which can eat right through your skin which creates an ulcer and ultimately and infection (especially bad if you are diabetic).

You can also have your podiatrist remove the corns by paring or debriding them away. Rarely does this cause a problem but many people will get many months’ worth of relief.  If you are a diabetic or have poor circulation you should get your corns taken care of on a periodic basis.

Other treatments include a combination of non-steroidal anti-inflammatory (NSAIDS) along with orthopedic inserts or orthotics that can give temporary relief. 

At this point if you are not ready to stop wearing those heels, or you don’t want to keep coming back to the doctor to get your corns removed, you may have to entertain surgical correction.  When we evaluate hammertoe surgery we look at the architecture and alignment of all the toes even the ones that don’t hurt.  There are a few different types of surgery for hammertoes and your doctor will decide which one is best for your situation. 

If you have any of the problems that were mentioned above, do not hesitate to call your local podiatrist to get rid of those pesky hammertoes and corns. Because remember, when your feet hurt, you hurt all over!