The toes consist of multiple osseous and soft tissues including tendons, nerves, and ligaments, all supporting our body weight. Each toe has several small bones called phalanges that connect to metatarsals, the longest bones in our midfoot.
Each toe is made up of three phalanx bones, which are the proximal, middle, and distal, except for the big toe which only has two phalanges, the proximal and distal. The primary function of your toes is to provide posture and balance, support the body weight, and propulsion during the gait cycle.
Not only do your toes help thrust your body forward when you walk, they actually help increase the length of your stride allowing you to run faster.
A hammer toe is a contracture deformity of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing several problems to develop along the way. Hammer toes typically begin as mild deformities and worsen progressively over time. In addition, there are two different types of hammer toes, such as:
- Flexible hammer toe – This type of hammer toe is less serious because it can be diagnosed and treated while still in the developmental stage. They are known as flexible hammer toes since they are still moveable at the joint.
- Rigid hammer toes – This variety is more developed and much more serious than flexible hammer toes. Rigid hammer toes can be seen in patients with severe arthritis, for instance, or in patients who wait too long to seek treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery more likely to be required.
Oftentimes, hammer toes can be misdiagnosed with another condition, such as a mallet toe and claw toe. Hammer toe and mallet toe are similar conditions that affect the joints of the toe. They both cause an abnormal bend in the toe, however, the major difference between the two is where the damage occurs in the toe joint.
Hammer toe affects the middle toe joint whereas mallet tow affects the upper toe joint closest to the toenail. As for a claw toe, the toe bends upward at the joint where the foot and toe bones meet, down at the middle PIP joint, and down again at the DIP joint. In contrast to claw toe, the DIP joint is extended in Hammer toe (bent upward).
Causes & Symptoms of Hammer Toe
A sudden abnormal muscle balance in your toe can lead to increased pressure on the tendon and joints, which results in a hammer toe. Other causes that may lead to this condition include the following:
- Trauma – In rare cases, trauma to your toe can result in a hammer toe. This includes any injury in which you stub, jam, or break your toe.
- Ill-fitting shoes – Shoes that are narrow and do not fit well, such as high heels, offer little to no arch support. High heels also put pressure on the toes and cause them to bend at the joints. High-heeled shoes also are usually too narrow in the toe box, the part of the shoe that surrounds the toes in a close-toe shoe.
- Arthritis – Arthritis is a common risk factor that can lead to hammer toe. It can make the joints of the toes stiff and sore. Inflammatory arthritis conditions like rheumatoid arthritis and gout have been linked to hammer toe.
- Medical conditions – Certain medical conditions such as a stroke, spinal injury, or diabetes can cause nerve damage that leads to the development of hammer toe.
Some patients tend to get hammer toes mainly due to biomechanical abnormalities during walking. Although there is an increase in occurrence among those who have flat feet, contracted toes can appear in all types of feet.
An early sign may be that you have more difficulty or pain wearing your shoes. The longer you have a hammer toe, the more rigid and contracted the deformity may become.
Most people realize they have a problem when they develop painful calluses or blisters on top of their toes. In severe cases, ulceration and infection can develop with hammer toes. Other signs of hammer toes include painful calluses under the balls of the feet, cramping, and weakness. Sometimes a painful area can develop between your toes or on the side of a toe. This problem can also be caused by a small bone spur.
Other signs and symptoms linked to hammer toes include:
- Redness, inflammation, or a burning sensation.
- Swelling at the affected joint.
- Open sores (ulcers)
- Restricted or painful motion of your toe joint.
- Difficulty putting on shoes or taking shoes off.
- Claw-like toe appearance.
- Inability to flex the foot or wiggle the toe.
Who gets Hammer Toe?
There are a wide variety of risk factors that can lead to the development of hammer toes, such as the following below:
Neuromuscular diseases can increase the chances of experiencing a hammer toe. People with diabetes may be at risk for complications within the condition. For instance, a toe with corn or other ulceration indicates there is too much pressure on the toes. In people with diabetes who have poor blood flow or neuropathy, infected corns and lesions can lead to the loss of a toe or foot unless their shoes are modified.
While anyone can experience hammer toe, the risk for the condition increases with age. This is because over time the tendons that connect muscles become shorter, tighter, and less flexible.
Hammer toe is sometimes the result of nerve damage caused by drinking an excessive amount of alcohol, which could lead to alcohol use disorder. This type of damage can weaken the muscles of the foot and toes.
The foot type you are born with may predispose you to develop this type of joint deformity. Flat, flexible feet can lead to hammer toes as the foot tries to stabilize against a flattening arch. Feet with high arches can also form hammer toes as the extensor tendons overpower the flexors.
Females are more likely to experience hammer toe. This is due to the design of some footwear for women made with a narrow front end, causing the toes to become cramped.
Toes that are bent downward are commonly seen in people with post-polio syndrome, which can lead to toe deformities like hammer toe.
How Does Hammer Toe Affect You? How Serious is it?
In the early courses of a hammer toe, it might maintain its flexibility. However, the tendons of the toes can contract and tighten, causing your toe to become permanently bent. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses, which will require surgical treatment.
Recommended Treatment & Rehabilitation for Hammer Toe
During a diagnosis for hammer toes, your doctor will obtain a complete medical history of your symptoms and examine your foot. During the physical examination, your doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the affected toes.
In addition, your doctor may take X-rays to determine the degree of the deformities and assess any changes that may have occurred. Generally, hammer toes are progressive since they do not go away by themselves and typically will worsen over time. However, not all cases are the same. Some hammer toes progress more rapidly than others.
Once your doctor has evaluated your hammer toes, physiotherapy treatment may be advised to develop a specialized treatment plan that is suited for your needs. A physiotherapist will work with you by designing a set of treatments, such as the following:
It is important to regain the full range of motion of your toes and foot. Your physiotherapist will teach you a set of gentle stretching and movement exercises to help restore movement.
It is common to lose strength in the muscles of your foot, ankle, and leg after a toe injury. This is due to the change in activity and any bracing or boot used to restrict movement during healing. Your therapist will determine which muscles are weak and teach you specific exercises to strengthen them.
Manual therapy can be especially effective to restore movement in joints that become stiff after being immobilized. Your physiotherapist may gently move the joints involving your injury for you. This might feel like your foot is being gently wiggled.
Below are a few exercise examples for you to try at home in order to restore regular movement from mild hammer toe symptoms:
- Toe curl – Sit on the floor, with the heel of your affected foot on the floor. Next, gently curl your toes forward and then backward. Hold each position for about 6 seconds. Repeat 8-12 times a day.
- Towel scrunches – Sit in a chair and place your affected foot on a towel on the floor. Then, scrunch the towel toward you with your toes then use your toes to push the towel back into place. Repeat 8-12 times a day.
- Marble pick-ups – Put some marbles on the floor to lift up one marble from the floor at a time. Then try to put the marble in the cup. Repeat this method 8-12 times a day.
- Towel stretch – Sit with your legs extended and knees straight. Next, place a towel or belt around your foot just under your toes. Hold both ends of the towel or belt, with your hands above your knees. Pull back with the towel or belt so that your foot stretches toward you. Hold the position for at least 15-30 seconds, then repeat 2-4 times a day.
Alternative & Homeopathic Treatment for Hammer Toe
There are many different ways to ease your toes homeopathically after being treated. Some of these alternative treatments include:
- Taping – Taping your toes can change the muscle imbalance.
- Non-steroidal anti-inflammatory medications (NSAIDs) – Taking anti-inflammatory medications can help alleviate your pain.
- Padding – Padding around the hammer toe can minimize pressure.
- Fish oil – Omega-3 oils are perfect for supporting nerve health and preventing foot pain.
- Massages – Having a foot massage by a massage therapist can help seek out tender spots in your affected toe and other areas in your feet and press on them while gently stretching.
- RICE method – RICE stands for rest, ice, compression, and elevation. Many athletes tend to follow this method in order to rule out further symptoms linked to hammer toe.
- Foot shower – Patients can bathe sore, painful, or tired feet in a bowl of warm water. Some individuals find that Epsom salts in the water can help ease the soreness much further.