Hammertoe

What Is It?

The smallest four toes of each foot have three bony segments beyond the toe webs (skin between the toes), just as the fingers do. Hammertoe is a deformity in which one or more of the small toes develops a bend at the joint between the first and second segments (the joint just beyond the toe web) so that the toe tip is turned downward, giving it the appearance of a hammer or claw. The second toe is affected most often.

Most hammertoes are caused by the long-term wearing of ill-fitting, tight or high-heeled shoes. Constrictive footwear crowds the toes, putting pressure on the middle toes and causing them to curl downward. Hammertoe also can be caused by a deformity known as a bunion, which is the knobby bump that sometimes develops at the side of the big toe. A bunion causes the big toe to bend toward the other toes of the foot, and the big toe can then overlap and crowd the smaller toes. Occasionally, a hammertoe is inherited or caused by arthritis in the toe joint.

If the toes remain in the hammertoe position for long periods, the tendons on the top of the foot will tighten over time because they are not stretched to their full length. Eventually, the tendons shorten enough that the deformity becomes unmovable, even when shoes are not being worn.

Symptoms

The symptoms of hammertoe include:

• A curling toe
• Pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward
• Thickening of the skin above or below the affected toe with the formation of corns or calluses
• Difficulty finding shoes that fit well

In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.

Diagnosis

Most health care providers can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can result in hammertoe. If the deformed toe is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).

Expected Duration

Unless treated, hammertoe is permanent.

Prevention