Brief overview
- Treatment: fitting or orthopedic shoes, orthotics, shoe inserts, taping, surgery such as a tendon repositioning or joint reconstruction.
- Causes: Unsuitable, too tight footwear, foot malpositions such as splay foot, pointed foot and hollow foot, other toe malpositions such as hallux valgus
- Symptoms: Pain, which often occurs later in life, gait disturbances and deformation of the toes as an aesthetic problem.
- Prognosis: The earlier the treatment of a hammer toe, the better the prognosis. However, in some cases, affected individuals develop a hammertoe again.
- Prevention: Wearing shoes that fit and are as flat as possible can prevent a hammertoe. It is especially beneficial to walk barefoot.
What is a hammer toe?
Most people affected by a hammertoe also suffer from a foot deformity such as a splayfoot, high arch or bunion (hallux valgus). Rarely, a hammertoe is congenital.
In addition to hammertoe, there are other toe deformities that are very similar to it. Here, however, the individual toe limbs are malpositioned in a different way.
Claw toe (Digitus flexus)
However, the claw toe is not the same as the claw foot (also hollow foot, pes cavus). This is a deformity of the entire foot.
Mallet toe
In contrast to the hammer toe, in the Mallet toe both the base joint and the middle joint are extended. The toe points straight forward over these two joints. In the terminal joint, the toe is curved to such an extent that the tip of the toe points to the ground here as well.
How is a hammer toe treated?
If the toes are only slightly curved and there are only slight pressure points, it is often sufficient to adjust the shoes individually. One possibility, for example, is to widen the toe cap or to use new shoes with a wider toe box so that the toes have more space in the shoe again.
Recent studies have shown that in many cases support stockings, which generate a maximum pressure of 18 to 21 mmHg, have a positive effect on hammertoes and reduce discomfort.
In many cases, however, only hammertoe surgery helps. When choosing the surgical method, the decisive factor is how much the toe is curved and whether it can still be moved.
Tendon displacement
Joint reconstruction
If the toe bones are more deformed, the surgeon removes a piece of the middle or proximal phalanx. He then straightens the toe. Sometimes the doctor inserts a small wire into the affected toe. It is designed to stabilize the toe in the corrected position and is removed after a few weeks.
Tapes as alternative aids
The effectiveness of kinesiotapes is not medically proven. If complaints persist and reoccur despite the tapes, it is recommended to consult a doctor.
How does a hammer toe develop?
Most hammertoes develop over a long period of time in the course of life. There are certain risk factors that promote this deformity:
Improper footwear
Accompanying foot malposition
A splayfoot or high arch changes the arch of the foot. If the foot is overloaded or misloaded in one of these deformities due to excess weight or unsuitable shoes, the forefoot loses its tension. The longitudinal arch drops and the toes move apart. This changes the direction of pull of the muscles and tendons. The toes then curl like a hammer.
Neurological disorders
In spastic paralysis, muscle spasms (contractures) sometimes occur in the feet, resulting in a hammertoe. Hammertoes also develop more frequently in other neurological disorders such as Friedreich’s ataxia. This is because sufferers often also have high arches, which pose a risk for hammertoe.
After trauma
Rheumatism
Rheumatoid arthritis is a chronic inflammation of the joints. It is a disease that occurs in the toe joints and also promotes hammertoe.
What are typical symptoms of a hammer toe?
A hammer toe does not necessarily lead to symptoms. Usually, those affected only go to the doctor when they have severe pain. Others suffer from the fact that their foot shape changes visually due to the hammer toe. In these cases, a hammertoe is more of an aesthetic problem.
With all the symptoms described, it should be noted that they are not necessarily related to the degree of deformity. Even a mildly pronounced hammertoe causes severe discomfort in some cases, while other people experience no symptoms even with severely pronounced hammertoes.
How is a hammertoe diagnosed?
Sometimes X-rays of the foot help with the diagnosis. They are mainly used to plan hammertoe surgery.
Course of the disease and prognosis
Without treatment, the malposition continues to worsen over time. The prognosis is then significantly worse.
