Hammer Toe: Causes, Symptoms and Treatments

What Is a Hammer Toe?

A hammer toe is a common deformity characterized by an abnormal flexion of the proximal interphalangeal joint of a toe, giving it a curved shape resembling a hammer. The second toe is most frequently affected, but this condition can affect any toe.

At our Laval clinic, we regularly see patients suffering from hammer toes. This deformity affects women more often and becomes more common with age. Early treatment can often prevent the need for surgery.

Types of Deformity

Flexible Hammer Toe

In the early stage, the toe can still be straightened manually. The joint retains some mobility, and conservative treatments are generally effective at this stage.

Rigid Hammer Toe

Over time, the tendons and ligaments contract permanently. The toe becomes fixed in its bent position and can no longer be straightened without surgical intervention.

Causes and Risk Factors

Biomechanical Factors

• Muscle imbalance: an imbalance between the flexor and extensor muscles of the toe causes the abnormal flexion
• Hallux valgus: a bunion can push the second toe upward, creating a hammer deformity
• Foot type: a second toe longer than the big toe (Greek foot) is more predisposed

External Factors

• Inappropriate footwear: shoes that are too narrow, too short or high-heeled force the toes into a curled position
• Trauma: a fracture or injury to the toe can alter joint alignment

Associated Medical Conditions

• Rheumatoid arthritis or osteoarthritis
• Diabetes with peripheral neuropathy
• Neuromuscular diseases

Symptoms

Hammer toe symptoms include:

• Visible deformity: the toe presents an abnormal flexion at the central joint
• Pain and discomfort: especially when wearing closed shoes
• Corns and calluses: skin lesions form at friction points, on top of the toe or at the tip
• Joint stiffness: increasing difficulty moving the toe
• Inflammation: redness and swelling around the joint

Diagnosis

At our Laval clinic, the diagnosis includes:

1. Clinical examination: evaluation of the toe's flexibility and the severity of the deformity
2. Biomechanical assessment: gait analysis and foot structure evaluation
3. X-ray: to visualize joint alignment and rule out other conditions

Treatments Offered at Our Clinic

Silicone Orthoplasty

A custom-moulded silicone device protects the deformed toe, reduces friction inside the shoe and can help gradually reposition the toe.

Custom Foot Orthotics

Foot orthotics correct the biomechanical imbalances that contribute to the deformity. They redistribute pressure and stabilize the foot inside the shoe.

Exercises and Stretches

An exercise program aimed at strengthening the intrinsic muscles of the foot and stretching the contracted tendons can help maintain the toe's flexibility.

Corrective Surgery

When conservative treatments are insufficient and the deformity is rigid, surgery may be considered to permanently straighten the toe.

Prevention

• Wear shoes with a wide and sufficiently deep toe box
• Limit wearing high heels to short periods
• Practice daily toe flexibility exercises
• Consult a podiatrist at the first sign of deformity, even if mild