Hammer toe as well as claw toe is misalignment of the toe joints, visible by curvature of single or multiple toes. Correctable is the hammer toe (claw toe) initially by conservative methods, but in advanced stages only by surgical measures.
What is hammertoe (claw toe)?
The usually painful deformities of individual toes are known as hammer toe or claw toe. You can recognize these deformities by the curvature of the toe joints. One speaks of a hammer toe if the end joint of the toe is bent when the base joint is extended. If one suffers from a claw toe, the middle or end joint is curved, while the base joint of the toe is hyperextended. Both toe deformities can be diagnosed relatively often, with the predominance of the hammer toe. It often happens that in addition to the maldevelopment of the hammer toe or claw toe, a deformation of the big toe is also observed. This is referred to as “hallux valgus“.
Causes
What are the causes for the pathological development to hammer toe or claw toe? Wearing shoes with too high a heel or shoes that are too narrow is primarily responsible. The toes do not have sufficient space. They bump against the tips of the shoes and can therefore gradually become crooked. Since the toe muscles are hardly ever moved nowadays – especially because the foot usually remains cramped in orthopedically unfavorable shoes all day – they atrophy and the development into hammer toe or claw toe is only a matter of time. But also a malposition of the foot such as splay foot, flat foot or bent foot can promote the development of hammer toe and claw toe. Neurological diseases as well as muscle or nerve injuries of the foot or even the lower leg can also be causative factors. Less commonly, genetic factors are responsible for hammertoe or claw toe.
Symptoms, complaints and signs
Hammer toe or claw toe has a characteristic appearance. The main symptom here is a typical toe deformity in which the middle phalanx of the toe is hyperextended upward and the end phalanx of the toe is pointed downward. The shape of the toe thus resembles that of a hammer. The difference between a hammer toe and a claw toe is that in the former, the top of the toe touches the ground. In many sufferers, more than one toe of the foot is affected by deformity. In many cases, those affected are free of symptoms apart from purely cosmetic aspects. In others, however, the malpositioning of the toes causes instability, which can lead to pathological stress on the foot. This is particularly the case if several toes of the foot are deformed. This can result in pressure points and severe pain. In advanced stages, further deformation of the hammer toe or claw toe occurs. The pain intensifies over time. The affected toe continues to shorten and at the same time requires more space in height. Especially by wearing shoes that are too tight, this can lead to the development of corns or painful calluses.
Course
The hammer toe, respectively the claw toe develops relatively inconspicuous at first: one day you observe a small elevation on one toe or several toes. If one neglects to visit the orthopedist in time, the small bony changes gradually develop into unsightly humps. The toe becomes more and more deformed, the middle or end joint becomes bent and bumps against the top of the shoe. The result: pressure points on the toe make walking a painful ordeal. Corns develop, which can easily become inflamed and cause infections due to the constant rubbing against the shoe. Diabetics are particularly at risk due to the extreme sensitivity of their feet. Failure to treat hammertoe (claw toe) in a timely manner can result in complete crippling and stiffening.
Complications
Due to hammertoe, there are various complaints and deformities of the toes. The further course of the disease usually depends greatly on the exact complaints and symptoms. However, in most cases, there is a delayed diagnosis of the disease by the patient himself. The reason for this is that the complaints are initially only inconspicuous and cannot be assigned to the hammer toe. Only in the later course of the disease do symptoms and changes in the bones become apparent.The toes become crooked and can lead to severe pain. These occur mainly when walking and can cause movement restrictions. It is not uncommon for the so-called corns to occur. Furthermore, the affected person can easily get inflammations and infections at the toes. The feet are particularly sensitive due to the disease. The treatment of hammertoe usually depends on its severity. In many cases, no surgical intervention is necessary. There are no further complications. Various insoles, therapies or implants can be used to alleviate the symptoms. Life expectancy is not limited by hammertoe.
When should you go to the doctor?
A hammertoe does not always cause discomfort and usually does not require treatment. However, if pain or further deformities develop, a visit to the doctor is recommended. If pressure sores and corns occur in connection with a claw toe, orthopedic measures must be taken. Infections, bleeding and other complications also require prompt evaluation and treatment by a specialist. Diabetics are particularly susceptible to hammertoe. When the first signs of deformity are noticed, the appropriate physician should be informed. Hammertoes are also more common in people who suffer from splay, flat or bent feet. Other risk factors include tight or improperly fitting shoes, neurological disorders, and muscle or nerve injuries. Anyone who belongs to these risk groups should have initial symptoms clarified immediately and visit a doctor’s office in the next few days in the event of acute symptoms. If ulcers or infections develop as a result of hammertoe, this must be treated immediately, because otherwise the complaints can take a serious course.
Treatment and therapy
If the deformity to the hammer toe or claw toe is not yet severe, a conservative, i.e. non-surgical, treatment is advisable. For example, the orthopedist prescribes special shoe inserts or night splints to stretch the toe overnight. He prescribes toe exercises with a physiotherapist. Wearing comfortable shoes made of soft leather is also indispensable. The pressure points can be additionally relieved by special pads. Regular visits to the chiropodist are also recommended. Here the treatment of corns is in the foreground. However, the deformity to the hammer toe (claw toe) can usually not be reversed by conservative therapy. For more severe deformities, only surgery will help. There are various ways to eliminate the curvature of the toes: The surgeon inserts an implant such as the SMART TOE, a newer and quite successful method, into the affected toe. This stiffens the toe joint, but stretches it and returns it to its original shape. Another method is to remove the affected bone while rebuilding the tendons and muscles. Surgery for hammertoe or claw toe is usually performed on an outpatient basis with local anesthesia.
Outlook and prognosis
The prognosis of a hammertoe is based on the severity of the deformity as well as the age of the patient. If the affected person is still in the growth and development phase, corrections can be made by wearing shoes or by special exercises of the limbs. If the hammer toe is only mild, the prognosis for the patient is favorable. In many cases, a cure can be achieved within a few months if all the guidelines are successfully implemented. With the completion of the growth phase, the prospect of complete correction normally worsens. Nevertheless, significant improvements can be achieved with orthopedic measures and individual gymnastics of the toes. If there is a severe deformity of the toes, correction can only lead to relief of the existing complaints by means of a surgical intervention. If the operation is performed without further complications, an improvement in the quality of life is achieved in most cases. Freedom from symptoms is rarely possible, but not impossible. The later medical care is initiated and the more severe the malformation, the less favorable the prognosis for the patient. In severe cases, a progressive course of the disease is to be expected or the toe as well as the foot joint must be stiffened.This will stop any increase in discomfort along the foot or leg.
Prevention
To prevent hammertoe or claw toe from developing in the first place, the following preventive measures should be taken: Above all, comfortable, not too tight shoes with heels not exceeding three centimeters are important. Regular toe exercises are also helpful. When walking, care should be taken to ensure that the feet roll properly – i.e. the toes are not curled. Those who consistently pay attention to the health of their feet need not fear suffering from hammer toe or claw toe.
Aftercare
During surgical correction of hammertoes, joints, tendons and bones are affected. To keep the toe in the desired position, it is fixed with tape bandages or a splint and wires. The tape bandages must be checked regularly and renewed if necessary. Wires are usually removed after fourteen days as part of follow-up care. In order for the toes to regain their former mobility, physiotherapy is almost always required and should be started as early as possible. As part of this therapy, the basal joints are exercised and the long tendons are stimulated. Initially, this may be accompanied by pain. It is therefore desirable that patients do not exercise alone initially, but under the guidance of a trained physiotherapist. Initially, two to three sessions per week are usually required. As soon as the pain subsides, patients can and should practice on their own. It is important to monitor the success of the therapy regularly. After about six weeks, it should be possible to bend the toes upward by 30 degrees and downward by about ten degrees with the foot extended. Further targets should be defined for the following weeks. In order for the operation to be permanently successful, behavioral adjustment on the part of the affected person is usually necessary. In particular, if the hammertoes were triggered or intensified by the wrong footwear, shoes with high heels or pointed toes are generally taboo in the subsequent period and should only be worn as an exception and even then only for a few hours.
What you can do yourself
A hammertoe is not necessarily a medical emergency. If it is detected at an early stage, the foot malposition can be corrected independently through targeted foot gymnastics and orthopedic measures. A medical clarification is therefore absolutely necessary. In consultation with the doctor, the footwear can then be checked and adjusted if necessary. Possible triggers for a claw foot are small or too narrow shoes, which are too tight especially in the area of the toes. In the case of slight pressure positions, it is sufficient to adjust the shoes individually. One possibility is to widen the toe cap to give the toes more space. Alternatively, the shoes can be fitted with so-called felt rings. These reduce the pressure on the sensitive toes and prevent pressure points. An orthopedist should be consulted in the case of significant deformities. He can recommend orthopedic inserts and, in severe cases, suggest surgery to correct the deformity. In any case, a hammertoe should be professionally examined and supported or corrected depending on its severity. If the deformity is left untreated, the clawed foot will increase in severity and cause further complications.
