What Are Hammer Toes?

Surely, you have seen them before, either on your grandparents’ feet, a stranger at the beach, or maybe even on yourself; you just did not know there was a name for them. We’re talking about abnormalities of the toes. The specific ones we are covering in this article are called hammer toes, and they can become a reason to worry if left untreated.

Hammer toes are some of the most frequent deformities of the foot. This article will outline what hammer toes are, their causes, management, risk factors, and a few other pieces of information on this medical condition.

Overview

Hammer toes are foot deformities which happen due to an imbalance, a loss of equilibrium between, in this instance, two body components. These are the weak intrinsic muscles and the bigger, more powerful extrinsic muscles surrounding the foot joint. Following this weakened balance between the two, the interphalangeal joints - the joints which connect the bones of the toes become somewhat locked in a flexed position, which will cause the visible deformity of the specific toe.⁴

Types of hammer toes

Let us now explore some of the types of hammer toes. They all involve the same mechanism described above; however, depending on the location and shape of the deformity, these are usually classified into the most common hammertoe, mallet toe or claw toe. These are important to acknowledge and be aware of, as even if they can not show any symptoms at the beginning (they can be completely painless), with time, these can affect one greatly. The smaller digits are a key part of the balance of the foot, hence the balance of the individual. They also support distributing pressure. Hence, deformities of the toes can lead to changes in the way we walk, cosmetic distortions, formation of callous bodies (thickened areas of skin), and pain, which is usually what will prompt us to seek medical input. It is, therefore, important to prevent this from happening and, ideally, present it to a medical professional early.⁴

Causes of hammer toes

There are multiple causes of hammer toes. Some of the most common are:

• Misfitting footwear. Footwear which does not fit (too short, too long, too narrow, shoes which put pressure on the toes such as high heels) will lead to pressure on your toes, which will, with time, cause deformities
• Arthritis
• Bunions
• High arches
• Some hereditary diseases (Charcot Marie Tooth disease, for example)
• Diabetes
• Age
• Hereditary, i.e., has been passed on genetically by your predecessors through some conditions or features that will cause toe deformities.^2,4

Signs and symptoms of hammer toes

Hammer toes can present with:⁴

• Rigidity in one or several joints of your toes
• Pain, usually at the top of the affected toe
• Pain in the ball of your foot
• Calluses at the top of the affected joint
• Redness or swelling

Management and treatment for hammer toes

What are the options for someone experiencing deformity of their toes? There are plenty of treatment options to consider, starting with conservative measures to surgical interventions if the issue persists.

Conservative measures include wearing shoes with a wider fit, pads between toes and some specialist orthotic equipment your doctor would be able to advise on. The main focus of conservative measures is around offering relief of pressure on the involved toes. These would be able to accommodate the deformities and alleviate the pain that these may cause.¹

If conservative measures fail to show any improvement, some patients may benefit from surgery. There are plenty of surgical approaches which a qualified surgeon would be better able to advise on. They would be able to advise on this following a clinical examination of the patient.

As conservative measures are usually mostly focused on the symptoms, the definitive treatment will most likely consist of surgery due to the progressive nature of the problem. The surgical procedure is generally straightforward, done under local anaesthesia, and most often done as an outpatient, meaning an overnight stay will be unlikely needed. 

Following surgery, daily activities, which include walking, will most likely be limited in the first instance until the soft tissue heals and the swelling reduces in size. During the recovery period, the foot will need to be kept elevated as much as possible to reduce the swelling.

The surgery itself focuses on releasing the stiffness in the soft tissues and tendons, which will further allow the repositioning of the joints.^1,4

Diagnosis

When it comes to hammer toes, diagnosis is primarily clinical, meaning that a specialist doctor would be able to diagnose the condition following clinical examination and differentiate between different types of conditions affecting the toes. 

They will very likely advise you on getting some imaging before being able to diagnose the condition correctly. These would include either plain radiographs or, in more serious deformities possibly associated with wider symptomatology, Magnetic Resonance Imaging, which can provide a more thorough look at the possible tissues affected surrounding the bone and joints.

These are mostly differentiated by the exact joint which is affected (it is important to note that there are numerous joints within the human foot, as well as within the toes). Depending on the affected joint, we can mention claw toes (a condition frequently associated with neurological disorders) and mallet toes, to name some.^3,4

Risk factors

As with most risk factors, these are somewhat overlapping some of the causes. 

These include, but are not limited to:

• Neuromuscular conditions
• Diabetes
• Inflammatory conditions such as arthropathies
• Ill-fitting shoes 
• Long bones of the toes⁴

FAQs

Can hammer toes be prevented?

An efficient way of preventing hammer toes from happening is making sure you wear well-fitted shoes. Avoid wearing shoes that are too narrow or high heels higher than 2 inches. Instead, go for a shoe which provides at least ½ inch space between the end of your longest toe and the tip of the shoe. 

How common are hammer toes?

Approximately 3 million people in the UK will have hammer toes or a variation of this.

Do hammer toes hurt?

Hammer toes can cause pain to develop, particularly due to friction against shoes. The calluses which form following this can be particularly painful.

When should I see a doctor?

Get in touch with your GP straight away with any symptoms of hammer toes. These can comprise rigidity in a joint in your toe, pain at the top of your bent toe, pain in the ball of the foot, redness, swelling or inflammation.

Summary

Hammer toes are foot deformities that happen due to an imbalance between the intrinsic and extrinsic muscles surrounding the foot joint. These can produce undesired symptoms, such as pain and swelling, hence why you should see your GP at the earliest signs of the condition.