Hammer Toe

The Hammer toe or claw toe is the most common deformity of the second, third, or fourth toe. It is a toe that has an abnormal bend in its middle joint, making the toe bend downward to look like a hammer. This deformity is characterized by bending or curling of the toe downward instead of being in the normal straightforward position. Over a period, as the deformity progresses, eventually, the toe is stuck in a claw-like position.

Women are more prone than men to develop hammer toe, other causes can be:

• Genetically transferred.
• Women are more prone than men to develop hammer toe.
• Injury to the brain, spinal cord, or nerves such as stroke, degenerative disc disease, and cerebral palsy.
• Stagnant for prolonged periods in bed.
• Breaking a toe.
• Imbalance in the muscles, ligaments, and tendons of the toes.
• Muscle weakens.
• Injuries.
• Longer toe length.
• Certain diseases like arthritis, diabetes, and peripheral arterial disease.
• Shoes with narrow, little, and no arch support.
• Tight shoes.

Symptoms may vary depending on the degree of the bend. Commonly found symptoms are:

• Swelling, redness, or a burning sensation.
• Sores.
• Upward bent toe.
• Inability to straighten the toe.
• Pain while moving it or wearing shoes.
• Corns and callouses.
• Blisters.
• Pain while walking.

Pathology:

Hammer toe is a chronic, sustained imbalance between flexion and extension force of the toes from intrinsic forces, extrinsic forces, or both. Hammertoe deformity involves flexion deformity of the PIP joint of the toe, with hyperextension of the MTP and DIP joints.

Physical examination:

The examiner checks the toe by gently moving the foot and toe to cause symptoms to occur. This helps the examiner to thoroughly evaluate the condition of the toe.

X-rays

X-rays are done to examine the bone and joints of the feet and toes

Medication: NSAIDs, corticosteroid injection, etc.

Note: Medication should not be taken without the doctor's prescription.

Surgery:

If the hammer toe is not treated immediately, then it may become fixed and require surgery to correct. Surgery is done to reposition the affected toe, remove any deformed bone, and realign the tendons to relieve the symptoms. During the surgery, the tight tendons and muscles are released so that the toe can straighten again.

Rest:

Rest is recommended as a weight off the feet allows inflammation reduction.

Cryotherapy:

Cold pads or ice therapy is used to reduce pain, swelling, and soreness of the toe.

Proper footwear:

Properly fitted shoes with big toe boxes, so that the shoes have ample space to accommodate the toes are recommended.

Supports and Pads:

Toe pads or insoles in the shoes can be worn while performing special toe exercises. These treatment steps encourage the toe to straighten while strengthening the toe muscles to become more flexible. Corn pads and foot straps are used to relieve some of the painful symptoms.

Splinting:

Splinting is done to keep the hammer toe straight, it stretches out the tendons and muscles of the toe.

Taping:

Taping is used for milder cases where the affected toe is still flexible. A piece of tape is wrapped under the big toe, over the hammer toe, and under the toe next to the hammertoe to help keep it straight.

Stretching Exercise:

Stretching exercises use hands to gently stretch and move the affected toe, manually several times a day, increasing flexibility.

Range of motion Exercises:

Hammer toe is best treated by early intervention when the muscles and joints are still more flexible. The physiotherapist works on relaxing the area so that the joints can shift back into their natural location. Range of motion exercises helps to preserve flexibility and function in the joint. Examples of these exercises are picking up various small and bigger things using the toes is also a great exercise that can be done, picking up marbles and towels seem to correct the hammertoe efficiently, put a towel under the foot and use the toes to crumple it or another example can be toe-spread exercise, which can be also done.

Strengthening Exercises:

Strengthening the joint by strengthening exercises helps preserve motion in the joint that can be lost because of prolonged joint stress. 

The person with a hammer toe wears improper footwear and might have ignored the development of the hammer toe, and thus might require surgery to release the tendons. Hammer toe, like many other foot problems, can be avoided by wearing proper footwear, and low heels with enough toe room. Shoes should be of proper size and should accommodate the longest toe, with adjustable laces and straps and proper arch support which prevents several foot ailments. Even after treatment, the hammer toe may return to make sure that the hammer toe does not reoccur therefore proper footwear should be worn.