Diagnosis
To diagnose hammer toes, a look at the patient’s bare feet is usually sufficient. In order to determine the extent of the malpositioning, the doctor will, if necessary, examine whether the toes can still be passively brought into a normal shape. He will also look for other phenomena on the foot, which are often associated with hammer toes.
These include calluses and pressure points on the one hand and other malpositioning such as a splayfoot or a lateral curvature of the big toe (hallux valgus) on the other. In addition to the examination and observation, the physician will, if necessary, ask the patient’s habits, for example, which shoes are worn. A further diagnostic procedure is usually not necessary for hammer toes. In the case of clearly deformed toes or severe pain, it may be appropriate to have an X-ray of the foot taken. The same applies if surgery is planned to correct the deformity.
Therapy
In hammer toes, especially in the early stages, various non-surgical therapy methods are used to counteract an increase in the malpositioning of the toe and to alleviate the resulting complaints. This can be achieved with various aids such as traction bandages, night splints or inter toe orthoses. In addition, however, treatment should always be carried out by actively implemented measures.
Toe gymnastics, exercises and regular barefoot walking strengthen the foot muscles and thus prevent a deterioration of hammer toes. It is also essential to avoid triggering circumstances such as wearing shoes that are too tight or high heels. Regular foot care is also an important part of the treatment to prevent the formation of painful calluses.Often, however, despite the exhaustion of all mentioned treatment measures, there is not sufficient relief of symptoms and a steady progress of hammer toe malpositioning.
The only remaining treatment option is usually surgery to correct the malpositioning. Depending on the severity of the deformity, different procedures are possible. In severe cases of hammer toes and after unsuccessful treatment with other methods, there is often only one surgery left to treat the deformity.
It is also the only form of therapy that can correct hammer toes in the long term. If the malposition is only slightly pronounced, the long extensor tendon is relocated. Hohmann’s surgical method is most widely used for the most advanced stages.
In this procedure, an upwardly protruding part of the bone is removed. This straightens the toe and also removes tension from the extensor tendon, as the length of the bone is shortened. The produced correction of the toe is stabilized by means of a wire inserted over the entire toe length.
After two to three weeks the bone has healed sufficiently for the wire to be removed. In the case of particularly severe malpositioning, the only remaining option is often a bony stiffening of the affected toe joints. Surgical correction of a hammer toe deformity cannot be performed if there is a severe circulatory disorder, as otherwise good wound healing cannot be guaranteed.
How long one is ill after surgery for hammer toes depends on the complexity of the operation, the previous condition of the patient and the healing process. Smaller operations can usually be performed on an outpatient basis, i.e. you can leave the hospital soon after the operation. In the case of larger or more complicated operations, in-patient treatment for a few days may also be necessary.
In both cases, the affected person can usually appear the day after the operation with a special forefoot relief shoe and walk a few steps. After a few days – depending on the healing process and the doctor’s instructions – normal footwear can already be used again. The healing period is usually between three and six weeks.
How long one is ill, however, depends on the degree of activity and the professional activity. During the healing phase, the foot should only be loaded step by step, but it is not necessary to rest the whole time. With hammer toes, there are various splints that are designed to counteract an increase in malpositioning and alleviate symptoms that have already arisen.
Most of them are over-the-counter products. On the one hand, so-called correction pads are often offered. These are soft insoles which are placed on the sole in the area of the forefoot and the toes.
Loops that surround the toes start from this pad. This is intended to cushion the forefoot and pull the toes towards their natural position. While this type of splint is designed to work while walking, there are also hammer toe splints that are only worn at night.
These are designed to return the toes to their natural shape by pulling them gently. Whether such freely available splints have a positive effect on hammer toes has not been proven. Custom-made aids such as orthopedic insoles are generally recommended.
In the case of a pronounced malpositioning and severe complaints, treatment with aids such as splints alone is usually no longer sufficient and only a surgical intervention offers the prospect of a successful therapy. The taping of hammer toes is one of the non-surgical treatment options. Using various adhesive techniques, the kinesiotapes can be applied in such a way that the tendons on the toes are relieved and the development of pressure points can be prevented.
Professionally performed taping can thus be used to counteract the progression of the malpositioning in hammer toes. However, once a curvature of the toes has occurred, it cannot be straightened again. If, despite taping, an increase in the malpositioning or complaints such as painful pressure points occur, it is recommended that you seek medical treatment.
If other non-surgical methods do not promise success or fail, there is usually only one surgical procedure to treat hammer toes in the long term.To treat complaints such as pressure points and pain due to hammer toes, so-called hammer toe pads can be purchased in drugstores and pharmacies. This is a type of plaster with padded inserts that is stuck to the sole of the foot in the area of the first toe links. This is to protect the metatarsophalangeal joints of the toes from pressure and thus prevent skin irritation and corns due to hammer toes.
Ultimately, the manufacturers promise that this will noticeably increase the resilience of the feet. Some hammer toe pads release additional mineral oils to the skin and provide it with moisture. No general statement can be made as to whether hammer toe pads help or not in case of a malpositioning of the toes.
Some users report a significant alleviation of discomfort and a reduction in pressure points and corns. In other patients, however, hammer toe pads do not have the desired effect despite regular use. In general, such aids cannot reverse existing malpositioning once it has occurred.
Anyone suffering from complaints due to hammer toes should seek medical treatment, as these tend to increase. There are specially adapted shoes that can be worn for hammer toes to relieve discomfort and counteract a worsening of the malformation. Individually inserted pads are intended to provide relief for the painful region.
In addition, the shoes usually contain a soft, large toe box so that as little pressure as possible is exerted. The best place to obtain advice on the manufacture of special shoes for hammer toes and possible alternative aids is a health food store. Such shoes are useful, for example, if there are complaints due to hammer toes but surgical treatment cannot be performed or is rejected by the patient.
Exercises and gymnastics can certainly help to prevent the development of hammer toes. These measures also serve to counteract the progression of hammer toes. The simplest possibility is to occasionally walk barefoot on a suitable surface.
You can also train the muscular strength and mobility of the feet, for example by trying to grab objects such as marbles or a towel with your toes. In addition, you should occasionally try to passively bring the hammer toes into their natural shape with your hands. However, no force should be used.
Exercises and gymnastics can alleviate complaints caused by hammer toes and prevent them from getting worse. Once a malalignment has occurred, it can only be corrected by surgery. For the non-surgical treatment of hammer toes, special insoles for the shoes can be used.
This is intended to support the toes and counteract a shortening of the tendons. The insoles should be custom-made, since the individual requirements of the feet are very different. It is best to get advice on the use of insoles for hammer toes in a health food store. Wearing insoles can relieve complaints such as pain. However, hammer toes that have already existed cannot regress.
