Hammertoes are a contracture of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. When they are rigid, it is not possible to straighten the toe out by manipulating it. Frequently, they develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callous on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callus to form (Calluses and Corns).
They tend to slowly get worse with time and frequently flexible deformities become rigid. Treatment can be preventative, symptomatic, or curative. For information on hammertoe of the big toe see Hallux hammertoe.
Preventative treatment of hammertoe is directed toward the cause of the deformity. A functional orthotic is a special insert that can be prescribed by your podiatrist to address the abnormal functioning of the foot that causes the hammertoe. Functional orthotics can be thought of as contact lenses for your feet. They correct a number of foot problems that are caused by an abnormally functioning foot. Our feet, much like our eyes, change with time. Functional orthotics slow down or halt this gradual change in the foot. Often when orthotics are used for flexible hammertoes, the toes will over time straighten out and correct themselves. Calf stretching exercises are also helpful. Calf stretching can help to overcome part of the muscle imbalance that causes the hammertoe.
Symptomatic treatment of hammertoes consists of such things as open-toed shoes or hammertoe pads. There are over-the-counter corn removers for temporally reducing the painful callus often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callous off. These medications should never be used for corns or calluses between the toes. Persons with diabetes or bad circulation should never use these products.
Curative treatment of hammertoes varies depending upon the severity of the deformity. When the hammertoe is flexible, a simple tendon release in the toe works well. The recovery is rapid often requiring nothing more than a single stitch and a Band-aid. Of course, if several toes are done at the same time, the recovery make take a bit longer. For the surgical correction of a rigid hammertoe, the surgical procedure consists of removing the damaged skin where the corn is located. Then a small section of bone is removed at the level of the rigid joint. The sutures remain in place for approximately ten days. During this period of time, it is important to keep the area dry. Most surgeons prefer to leave the bandage in place until the patient’s follow-up visit, so there is no need for the patient to change the bandages at home. The patient is returned to a stiff-soled walking shoe in about two weeks. It is important to try and stay off the foot as much as possible during this time. Excessive swelling of the toe is the most common patient complaint. In severe cases of a hammertoe deformity, a pin may be required to hold the toe in place and the surgeon may elect to fuse the bones in the toe. This requires several weeks of recovery.
Complications associated with the surgery are infection, excessive swelling leading to delays in healing, and potential deviation of the toe. If excessive bone is removed during the surgery, the toe may be a bit floppy. The toe always has a floppy feeling for several weeks following the surgery. This is normal and generally not permanent.
If pinning the toe is not required during the procedure, then the surgery could be performed in the doctor’s office under local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be performed in an outpatient surgery center.