What are Hammer Toes?
“Hammer toes” is the term used to describe the collective physical deformity of the second, third, and fourth toe wherein they are permanently bent at one or two of their joints – usually at their middle joints or proximal interphalangeal joints.
Otherwise known as “contracted toes”, the condition earned its named for the resulting bowed appearance of the toes that made them look similar to hammers. The distortion of the normal contour of the toes is usually a result of wearing shoes that are too short or narrow and apply constant pressure to the toes, forcing them to be pushed together and lie obliquely – this is especially the case in shoes that are designed to narrow towards the toe box. Hammer toes can be easily detected through careful observation; the malformation of the toes start out as mild distortions but can get worse after some time especially if the factors causing the hammer toes are not done away with. If the condition is given attention early enough, the toes may still be flexible and can be treated without having to receive surgical intervention. However, if the toes are left untreated for too long, the muscles within the toes can stiffen further and will then require invasive procedures in order to correct the deformity.
Hammer Toes Causes
Most often, wearing shoes that do not fit an individual well for too often can actually bring about the condition. Wearing shoes that are too narrow or too tight for the owner for long periods of time can eventually take its toll on the wearer’s feet. This is the same for women who favour wearing high-heeled shoes with narrow toe boxes. The constant amount of pressure the foot receives due to the force of gravity that causes the feet to naturally slide down and press upon the lowest point of the shoe so they are unable to receive enough space to stretch out; this can result in the eventual distortion of the toes. The deformity comes as a result of the shortening of muscles inside the toes because the toes become accustomed to bent positions, thus prompting the muscles to fail to extend any further and become curbed and tightened. At first toes can still be stretched if unsuitable footwear is not being worn, but if the habit is persistent, the toes will eventually become used to the position they are constantly in so the muscle fibers inside them will eventually harden and refuse to stretch.
The incorrect position of the toes inside the shoes also causes the formation of calluses or corns on the surfaces of the toes that are constantly bent while a person is wearing the inappropriate footwear, due to the fact that these surfaces are constantly rubbing against the hard material of the interior of shoe, causing frequent friction.
Hammer toe can also be caused by other medical conditions, such as osteoarthritis, rheumatoid arthritis, and stroke because these illnesses involve affectation of the nerves and muscles. Diabetes is also a causative factor for hammer toes due to the diabetic neuropathy that comes along in advanced cases of diabetes. Injury incurred to the toes can also bring about the condition, especially if it involves breaking the toes.
Hammer toe can be hereditary in some cases. Some individuals can be genetically predisposed to developing the condition due to the natural structure of their bodies.
Hammer Toes Treatment
Hammer toes can be effectively corrected in various ways. Treatments can be non-invasive and simply involve physical therapy along with the sound advice that the patient must not wear any more shoes that restrict adequate space for the toes.
Appropriate shoes for people with hammer toes – or simply for those who wish to avoid the condition as much as possible – should be at least half an inch longer than the patient’s longest toe. High-heeled shoes must also be avoided.
The patient will be asked to practice some exercises for the toes to regain the normal movement and structure. These exercises usually involve stretching and strengthening the toes. The patient can try picking things up off the floor with the use of his or her toes alone, and he or she can also stretch the toes regularly by hand to ease them into straightening out. Another example of a physical exercise specifically for the toes involves crumpling a towel with the toes. The towel can lie underneath the feet and the patient can use the toes to scrunch up the towel while he is performing simple tasks such as watching TV or reading a book.
Symptoms of hammer toe can be helped through cushions or corn pads to alleviate them. If the hammer toes were brought about by an underlying disease, the patient must ask for the doctor’s advice before performing any exercises without professional medical consent.
It is also important for one who has hammer toes to remember that he must not try to treat or remove corns by himself. If open cuts result from attempts at removing these, infection can become possible. People who suffer from diabetes or conditions that lead to poor circulation in the areas of the feet should be especially cautious.
Hammer Toes Surgery
If the toes have become very inflexible and unresponsive to non-invasive methods, and if open sores have developed due to the constant friction the arched areas of the toes receive, patients can receive orthopaedic surgery to correct the deformity immediately. The operation is quick and is usually performed as an out-patient procedure. The doctor administers a local anesthetic into the foot region to numb the operating site. The patient can remain conscious will the procedure is being performed. Sedative can also be administered to help calm the patient down if he or she is much too anxious.
The technique which the surgeon will be applying during the surgery will depend on how much flexibility the affected toes still retain. If some flexibility has still been preserved in the affected toes, the hammer toes can be corrected through making a small incision into the toe so the surgeon can manipulate the tendon that is forcing the toes into the curved position. If however the toes have become completely rigid, the surgeon may have to do more than realigning the tendons. Some pieces of bone may have to be removed so that the toe can straighten out. If the latter is the case, some pins are attached onto the patient’s foot afterwards to fix the bones into place while the injured tissue takes time to heal.
After the procedure, the patient may have to deal with some swelling and stiffness while the recovery process is still ongoing. The patient should also expect that the toes which were corrected could look different after surgery, for example they could appear shorter or longer than before. The patient will be advised not to engage in too much physical activity that involves the feet for some time to give the injury from surgery time to heal.