Understanding Hammertoe Causes, Symptoms & Diagnosis

What Is a Hammertoe?

A hammertoe is a deformity of the second, third, fourth, or fifth toe in which the middle joint of the toe bends downward rather than lying flat. This creates an abnormal, claw-like position that can cause friction against the top of the shoe and lead to pain, corns, and calluses. In some cases, the toe may also press against adjacent toes, creating additional discomfort.

There are two types of hammertoes. A flexible hammertoe can still be moved at the joint and is generally easier to treat conservatively. A rigid hammertoe has lost its flexibility, meaning the joint is fixed in the bent position and typically requires surgical intervention to correct.

Causes & Risk Factors

Hammertoes most often develop as a result of a muscle and tendon imbalance around the toe joint. When the muscles that control toe movement are not working in balance, one set of tendons pulls more strongly than the other, causing the toe to buckle. Contributing factors include:

• An inherited foot structure, particularly longer second toes or certain arch types
• Bunions, which can push the big toe against the second toe and force it out of alignment
• Wearing shoes that are too tight, too narrow, or too short, cramping the toes into a bent position
• Arthritis or previous injury to the toe joint
• Neuromuscular conditions that affect muscle control in the foot

Symptoms

Common signs of a hammertoe include:

• A toe that is visibly bent or curled downward at the middle joint
• Pain or discomfort in the affected toe, especially when wearing shoes
• Corns or calluses on the top of the toe where it rubs against footwear
• Redness, swelling, or irritation around the affected joint
• Difficulty straightening the toe or moving it normally

Diagnosis

Dr. Barnes diagnoses hammertoes through a physical examination of the foot and toes. He assesses the flexibility of the joint, evaluates your gait and foot mechanics, and reviews your footwear. Digital X-rays are often taken to better understand the degree of the deformity and determine whether any bony changes are present. This information helps guide the treatment plan and determine whether conservative or surgical care is more appropriate.

Hammertoe Treatment Options Available at Our Council Bluffs Office

How Dr. Barnes Treats Hammertoes

Treatment depends on whether the hammertoe is flexible or rigid, how much pain it's causing, and how far the deformity has progressed. Dr. Barnes begins with conservative options whenever the toe still has some flexibility.

Conservative Care Options

For flexible hammertoes, non-surgical treatment can often relieve symptoms effectively and slow the progression of the deformity:

• Footwear modifications: Shoes with a deep, wide toe box take pressure off the bent toe and reduce irritation from rubbing. Avoiding tight or pointed footwear is one of the most important steps a patient can take.
• Padding: Cushioned pads placed over the top of the toe protect it from friction and reduce corn formation.
• Splinting and strapping: Taping or splinting the toe helps hold it in a more natural position and can reduce discomfort during activity.
• Custom orthotics: Orthotic devices prescribed by Dr. Barnes can address the underlying muscle imbalance and biomechanical factors contributing to the deformity.
• Toe exercises: Stretching and strengthening exercises for the toes and foot muscles may help maintain flexibility and slow progression in early-stage hammertoes.
• Anti-inflammatory medications: Over-the-counter NSAIDs can help manage pain and inflammation during flare-ups.

Surgical Options

When a hammertoe has become rigid, or when conservative care is no longer providing adequate relief, surgery is typically needed to correct the deformity. Dr. Barnes performs two hammertoe correction procedures, and the right choice depends on the specifics of your toe and the degree of deformity.

Hammertoe Arthroplasty

Arthroplasty is a straightforward procedure used to correct a hammertoe by removing a small portion of bone at the head of the proximal phalanx, the bone closest to the foot. Once the bone is removed, the toe is straightened, and the surrounding soft tissue is repaired to hold it in the correct position. This procedure is performed in the office under local anesthesia and is particularly well-suited for correcting a hammertoe of the fifth toe. Recovery typically involves wearing a surgical shoe for several weeks, with most patients returning to regular footwear and activities within about two months.

Hammertoe with Implant Surgery

For hammertoes requiring a more stable correction, Dr. Barnes may perform an arthrodesis, or fusion, of the interphalangeal joint. A small portion of bone is removed at the joint, the toe is straightened, and a small internal implant is placed inside the toe to hold the bones in proper alignment during healing. The implant provides stable fixation that supports solid bone healing and a durable, lasting correction. This procedure is typically performed in a surgical facility rather than the office. Most patients are able to progress into a walking shoe around four weeks after surgery, with bone healing largely complete by eight weeks. Dr. Barnes will discuss what to expect in detail before your procedure and monitor your progress closely throughout recovery.