3-Point Products' Healthcare Blog

My Toes are Crooked - Part 3: Hammertoes

  

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Crooked toes are not just a cosmetic concern, they can be painful and contribute to problems in the foot and ankle caused by an altered gait. The most common forms of crooked toes are:

http://emedicine.medscape.com/article/1235341-overview

1. Claw toes that extend upwards at the metatarsophalangeal joint and then bend down at the middle and end joints.
2. Mallet toes that bend down at the end joint near the toenail;
3. Hammer toes where the middle joint of the toe (the PIP or proximal interphalangeal joint) bends down and the end joint (the DIP or distal interphalangeal joint) bends up;
4. Curly toes where the toe bends down at all the joints.

Hammertoes are the most common deformity in the toes and the one this blog will concentrate on.

What is a Hammertoe?

Hammertoes are at least in part an imbalance of the ligaments and muscles in the toes. Wearing shoes that crowd the toes or high heeled shoes that force the toes forward into the narrowest part of the shoe can result in the toes being bent. The toes are forced to “grip” the bottom of the shoe to keep the toes from being forced to the end of the shoe.

Normally when you walk, the toes extend or straighten during the phase of gait known as “toe off”. If however the toes are crushed into a space that is too narrow or short, they may not have the room to extend and will tend to contract and bend rather than straighten. Over time this makes it difficult for the toes to straighten even when barefoot.

Toe off phase of gait. Note how all joints of the toes are extended; image source: http://www.courses.vcu.edu/DANC291-003/unit_9.htm

If in addition you have high arches or a natural tendency to keep the toes flexed, this can contribute to forming inflexible hammertoes. Some disease conditions including arthritis, diabetes, Charcot-Marie-Tooth, bunions and Morton’s toe (discussed in Part I of this blog series) also contribute to the development of hammer toes.

Can Hammertoes cause problems?

As noted in the previous blog about Morton's toe, any change in the structure of the foot that alters how pressure is distributed when walking will cause a problem. How severe the problem is depends on how severe the condition is.  When the toe is in a permanently bent position, the end of the toe tends to take an excessive amount of pressure resulting in the formation of calluses that can be very painful. Additionally, the bent middle joint of the toe tends to rub against the top of the shoe causing painful corns, calluses or skin breakdown on the top of the toe. It is usually when the top of the toe starts to rub on the shoe that people decide to do something about hammertoes. Unfortunately once the deformity has progressed to this point it may be too late for conservative treatment to be effective.

Our next blog will focus on how to treat hammer toes.  Look for it early next week!