Hammer Toes
© 1999 by Seth A. Rubenstein, D.P.M.

A hammer toe is a bent or contracted toe. Usually the toes lie flat on the ground, only bending during certain points while walking. Toes assist the foot in pushing off the ground during walking and running.

There are tendons which insert into the top and bottom of the toes which make them bend up or down. If one set of tendons overpowers the other or is used excessively due to an imbalance, the result is excessive bending of the toe. Over time this can lead to tightening of the tendon and later, contracture of the toe.

If the bent position of the toe can still be manually straightened out, the deformity is called a flexible hammer toe. When the contracture cannot be manually straightened out it is called a rigid hammer toe. There are two joints in the smaller toes (one in the Great toe). A contracture at the proximal joint (closer to the foot) is called a hammer toe. A contracture at the distal joint (furthest from the foot) is called a mallet toe. When both joints are contracted the deformity is called a claw toe.

Early treatment is directed at reducing the pressure on the contracted toe. This can be achieved by use of a lower heel height, deeper toe box shoe or sneaker, shaving down the corn, or accommodative padding. Sometimes functional orthotics may help the foot work more efficiently and reduce the imbalance of tendons, lessening the tendency toward hammer toe contracture.

When conservative care does not relive a painful deformity, surgery is recommended. This may involve cutting a tight tendon, and or removing a small portion of a toe bone which is under the corn. By doing so the toe contracture can be decreased along with the pressure point. In some instances, the toe joint may be fused in its new position in order to stabilize the toe or prevent recurrence.