Toe Deformities (Hammer Toes, Claw Toes)
A hammertoe is a deformity of a lesser toe (second through fifth toes), where the toe gets bent upward at the toe’s middle joint, resembling a hammer. The bent portion may rub against a shoe causing pain, irritation and development of corns. It is caused by wearing shoes that are too tight or narrow near the toes, when the second toe is larger than the first, and as a complication of arthritis and certain neuromuscular conditions.
Early stages of hammertoe are flexible and may be treated by conservative measures such as strapping, padding and wearing appropriate footwear. In more severe cases and when conservative treatment does not help, surgical correction is indicated. Surgery may include a tendon transfer procedure, where a tendon is rearranged from the lower side of the toe to the top, to pull the bent joint down and straighten the toe.
Stiff or fixed hammertoes may be corrected by joint resection or joint fusion (permanent straightening of the toe), which involves cutting tendons and ligaments of the joint and removing part of the bone to help straighten the joint. The straightened toe is held by pins for 3-4 weeks following surgery. Hammertoe correction is usually performed under local anesthesia on an outpatient basis.
There may be some swelling, redness, and stiffness following surgery. A special shoe may be provided to help with walking. As with any surgical procedure, hammertoe correction may be associated with a few risks including infection, bleeding, nerve injury or poor alignment of the toe.
Claw toe is a deformity, where a toe bends and appears like a bird’s claw. The affected toe is bent upward from the joint at the ball of foot, and downward at the joints in the middle and tip of the toe to curl under the foot. Hard thick skin called corns may develop under the ball of the foot or on the top of the affected toe, causing pain while walking.
Claw toe can occur in the four toes other than the big toe due to nerve damage, which weakens the muscles. They may be present at birth or acquired later due to other disorders such as rheumatoid arthritis, cerebral palsy and brain injury. Women are affected more often than men since claw toe can also form by wearing very tight or high-heeled shoes.
When you present to your doctor’s office with these symptoms, your doctor performs a physical examination of the foot and orders tests to rule out other nerve disorders that can weaken muscles in the foot.
Claw toe is first treated conservatively with regular stretching of the toe and toe joints, wearing soft comfortable shoes with a broader toe box, or splinting or taping to hold or align the toes in the correct position. When conservative treatment does not relieve symptoms, your doctor may suggest surgical correction of the toe.