Hammer Toes

What is a Hammer Toe

Hammer toes may occur in any toe except the big toe, most commonly the 2nd, 3rd and 4th. The toe is permanently bent at the middle joint  and may be flexible or rigid, The rigid toe is

often the most disabling as it is not capable of relieving pressure of its own accord and it often causes a 'back pressure'  onto the metatarsal area of the foot, in the metatarsals.  
There is often discomfort on the top of the toe due to rubbing against the shoe, resulting in corns and calluses both here and over the heads of the metatarsals.

What Causes It?

A Hammer Toe results from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight causing the toe's joints to curl downwards.

People who have high arched feet may develop a hammer toe because the toes begin to slide upwards on the metatarsal heads, just behind the toes. This change in the structures on the sole of the foot causes the ligaments and tendons on the top of the foot to lengthen and weaken.

Also, those with flat feet will also tend to develop hammer toes because as the weight is transferred across the middle of the feet during walking, the smaller toes are trying to gain purchase on the ground, curling in an attempt to grip.

Arthritis can lead to many different forefoot deformities, including hammer toes. This is due to changes within the joint caused by inflammation and destruction. Shoes that are too narrow, too short or too shallow will contribute to the problem whilst Hallux Valgus, or bunions, may overcrowd the 2nd toe, pushing it upwards.

What happens next...

When these damaged toes are forced into shoes, the shoe rubs on the bony prominences. This added friction commonly produces a corn, or callus overlying the prominent part of the toe, which is over the hammered joint, or on the end of the toe.  Constant pressure will also cause the toe to become red and swollen in that area and is very painful. This may result in bursitis.

Treatment and Prevention

It is really important that footwear has enough depth for the toes, to prevent friction and rubbing. Having the callus and corns removed by a podiatrist is recommended, especially if the person lives with diabetes. In this case, the corn may not be painful, but may be causing a breakdown of skin underneath the corn, leading to infection.

Conservative treatments include gel toe shields and gel toe caps to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

A word of warning, please do not use medicated corn pads as these often make the surrounding skin very moist and can cause an infection.

If the a hammer toe is causing a lot of problems and is a cause for concern due to infection, surgery may be appropriate.

"Is It a Bunion?" - Part 1 - Hallux Rigidus

"My bunion is playing up".

 The big toe joint causes a lot of trouble for some people, but it isn't always a bunion, even if the joint is swollen, red and painful.                                

Quite often it is a condition called Hallux Rigidus. The 'Hallux' refers to the big toe and 'Rigidus' means that the toe is rigid, or does not move easily. It requires very different treatment to a bunion.

 It is actually  a form of degenerative arthritis which is a progressive condition  and with time, stiffness develops in the toe.  In the early stages when movement is only slightly limited it is referred to as 'Hallux Limitus', but eventually the motion deceases and when the joint is very stiff, it becomes Hallux Rigidus.

We use the big toe joint for many activities, walking, climbing, kneeling, stooping or even standing and so, any inflammatory condition affecting the joint is very painful.

This type of arthritis is often referred to as 'wear and tear' and may be  attributed to the internal 

architecture of the foot, the way in which the joint moves in relation to the other joints in the foot.  There are many biomechanical discrepancies that can lead to this problem including excessive 'pronation' of the foot. Some people have occupations  that require putting excessive strain on the joint, for example climbing ladders or squatting for long periods of time. This may be the sole cause or it may be adding to the inherited problems. There is often a family history of Hallux Rigidus which may be due to the inherited predisposition and the bony alignment or even that career paths may also 'run in families'.

Hallus Rigidus may be caused by injury or trauma, such as stubbing the toe(common in athletes); or through suffering other inflammatory conditions such as gout or rheumatoid arthritis.

As Hallux Rigidus develops, the symptoms progress. Pain and stiffness are the first signs which are aggravated by cold, damp weather and made worse during certain activities (squatting, running). There may be inflammation around the joint combined with swelling. All of these may cause a limp and, as a result of the altered gait, knee, hip and back pain are often evident.

Your podiatrist can usually diagnose this condition by manipulating the toe, but an x ray would determine it.

Treatment involves reducing the inflammation and pain.

 Keeping the joint straight is very helpful and so thick stiff soled shoes are advised. For once, flexible trainers are not advised by the professionals! Well placed pads inside the shoe can reduce the movement in the joint and high heels are definitely not recommended. Avoid all activities which include repeated trauma on the joint, such as jogging. Once the inflammation has reduced, the pain will subside.  Ultimately the toe may become completely inflexible. This may not necessarily cause any problems, as  instinct is to hinge off the second toe joint if the first one is not functioning.