A hammerhead toe is a deformity of the toe that causes it to be bent sideways at the middle joint, resembling the head of a hammer. It is a relatively common condition that can affect any of the lesser toes, though it most often occurs in the second toe. While it may not always cause symptoms, if left untreated, a hammerhead toe can lead to discomfort, pain, and problems fitting into shoes. Here we will explore the causes, symptoms, diagnosis, and treatments for hammerhead toe.
What Causes a Hammerhead Toe?
There are several potential causes of hammerhead toe:
- Muscle/tendon imbalance – The toe has two tendons that help control its bending and straightening. If the tendon that straightens the toe becomes too tight or the tendon that bends it becomes too lax, an imbalance can occur resulting in a bending of the toe.
- Trauma – Injury to the toe, often from stubbing it, can damage the tendons and lead to a hammerhead deformity.
- Arthritis – Osteoarthritis or rheumatoid arthritis affecting the joints in the toe can cause inflammation and structural changes resulting in a hammerhead bend.
- Neurological conditions – Some neurological conditions like cerebral palsy, Charcot-Marie-Tooth disease, or spina bifida can cause muscle imbalances in the foot leading to hammerhead toes.
- Bunions – Having a bunion, an enlargement of the joint at the base of the big toe, can force the smaller toes to bend and become misaligned.
- Flat feet – Lack of arch support places strain on the toe joints which can contribute to hammerhead deformity.
- Wearing ill-fitting shoes – Shoes that are too tight, too short, or have a high heel can put excessive pressure on the toes and contribute to muscle imbalance.
- Genetics – Some people may have a hereditary predisposition for developing hammerhead toes.
Symptoms of Hammerhead Toe
Often people with hammerhead toe experience no symptoms. However, in some cases it can lead to the following:
- Corn/callus – A thickened area of skin may develop where the bent toe rubs against the shoe.
- Pain – Pain or discomfort in the affected toe joint that may get worse with activity.
- Inflammation – Swelling and redness at the joint of the bent toe.
- Difficulty with footwear – Hammerhead toes can cause problems fitting into shoes due to rubbing against the front of the shoe.
- Skin breakdown – In severe cases, the constant friction can lead to ulceration of the skin over the joint.
- Transfer sores – Decreased mobility of the affected toe can put more pressure on adjacent toes and lead to corns or calluses on those digits.
- Difficulty walking – In cases where multiple lesser toes are severely affected, it can disrupt normal gait and make walking more difficult.
Diagnosing Hammerhead Toe
Hammerhead toe is typically diagnosed through a physical exam by a doctor or podiatrist. The exam will involve inspecting the foot to check for any abnormalities in the shape of the toes. The joints of the affected toe will be palpated to check for tenderness, swelling, or reduced mobility. Imaging tests like X-rays allow the doctor to evaluate the bone structure and alignment of the toe in more detail. In some cases, blood tests may be ordered to check for underlying conditions like arthritis or diabetes that could be causing hammerhead deformity.
Non-Surgical Treatment for Hammerhead Toe
In many cases, hammerhead toe can be managed successfully without surgery using conservative treatments:
- Padding and taping – Applying padding or small pieces of tape to shield painful calluses and corns can provide relief.
- Toe spacers – Silicone or gel spacers placed between the toes can help realign toes and reduce friction points.
- Shoe modifications – Wearing shoes with a high and broad toe box reduces pressure on affected toes.
- Orthotics – Custom orthotic inserts for the shoes help support flat feet and improve alignment.
- Medications – Oral nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and swelling.
- Injections – Corticosteroid injections into the joint can reduce inflammation and pain.
- Physical therapy – Stretching and strengthening exercises can help restore muscle balance.
These conservative treatments focus on alleviating symptoms and preventing progression of the deformity. They may help avoid surgery, especially in milder cases caught early.
Surgical Options for Hammerhead Toe Treatment
If non-surgical methods fail to adequately relieve pain and improve toe position, there are a few surgical options to correct hammerhead toe:
Arthroplasty
Arthroplasty involves shaving off a small portion of the bone at the joint where the toe is bending. This allows the toe to straighten into better alignment. It is often done under local anesthesia.
Arthrodesis
Arthrodesis is the fusing together of the affected toe joint. The surgeon uses pins, screws, or wires to hold the bones stable so the joint can fuse into one solid bone. This prevents any further bending at the joint.
Resection
In some severe cases, the end of the toe may be surgically removed (resected) to address pain or improper rubbing against shoes. Skin and tissue are then closed over the shortened toe.
Tendon/Capsule Release
Release of contracted tendons around the toe or tight joint capsule improves alignment and mobility of the toe.
Surgery is typically performed on an outpatient basis under local anesthesia or mild sedation. Following surgery, the foot will be bandaged and the patient will need to limit activity to allow for healing over 2-4 weeks. Physical therapy helps rehabilitate the toes post-surgery.
Preventing Hammerhead Toe
You can reduce your risk of developing hammerhead toe by taking these preventive measures:
- Choose shoes with an appropriate size and shape for your feet. Make sure there is adequate space and toe box height.
- Avoid shoes with high heels that put pressure on toes.
- Use orthotics or arch supports if you have flat feet.
- Stay within a healthy weight range to avoid excess pressure on the feet.
- Warm up properly and stretch feet/toes before any strenuous physical activity.
- Allow any foot injuries time to heal properly to avoid chronic issues.
- Get periodic foot exams to check for any developing foot problems.
- Manage medical conditions like arthritis or diabetes to prevent complications in feet.
Outlook for Hammerhead Toe
With appropriate treatment, either conservative care or surgery, most cases of hammerhead toe can be successfully managed. Symptoms are typically relieved, though the bent appearance of the toe may persist. Rarely, cases that are severe, untreated, or develop complications like infection may ultimately require partial amputation of the toe.
By staying aware of proper footwear and getting periodic foot exams, you can minimize your risk. Seek medical care at the first sign of toe deformities or associated symptoms like calluses, pain, or trouble with shoes to improve your chances of successful early treatment.
Key Points
- Hammerhead toe is an abnormal bend in the middle joint of the toe, making it appear like a hammer claw.
- It often results from muscle imbalance but can also be caused by arthritis, injury, neurological conditions, or ill-fitting shoes.
- Symptoms include corns, pain, inflammation, and difficulty with footwear.
- Non-surgical treatment focuses on padding, orthotics, medications, and physical therapy.
- In severe cases, surgery may be needed to correct the alignment and fuse joints.
- Proper footwear and foot care habits can help prevent the development of hammerhead toes.
