Many of my patients ask, how do I even know I have hammer toes? What are they? Hammer toes are a condition in which the lesser toes of your feet (think all the toes that are not the big toe) have a contracture. The toe may be curled under when in fact it is supposed to be straight. There are rigid hammer toes that are not able to be straightened out, and there are flexible hammer toes that can be straightened out by pressing on them or in weight bearing. They may or may not cause pain, so you may not even realize you have a hammer toe. However it is better to be aware of this condition, and take steps to make sure it doesn't worsen.
Taking care of your hammer toes starts with the basics - start with choosing shoes that will be better for this condition. You want to look for a shoe with a rounded toe box in order to give the toes some room. Shoes with pointed toe box or a narrow tow box will crowd your toes.
If you wear these shoes, you will notice your hammer toes may be rubbing up against the top of the shoe. If the shoes are made of a flexible material such as cloth or mesh, you may be able to get away with wearing them. However a hard vinyl or synthetic material that does not easily stretch will aggravate those hammer toes.
You may look fashionable, but wearing those shoes may come with a cost! So in order to prevent aggravation of the toes, choose a shoe with a roomier, preferable round toe box. In addition, flip flops or shoes with minimal support will force your toes to curl with every step. So flip flops may aggravate your hammer toes.
If you do choose your shoes wisely but still find that there are areas of irritation. You want to inspect your feet after a long day and check if there are areas of redness, breaks in skin, blisters, or corns. A corn is a build up of skin to an area of irritation; it is your body's way to protecting itself. But that buildup of skin in an area that is already irritated can become painful. And in some patients, it can even lead to an open wound if not cared for. For softening that hard skin, our office carries urea cream.
It comes in either 20% or 40% cream, and this particular cream is used as an emollient that can soften hard skin on your feet and heels, especially those areas of hard skin build up. So applying urea cream twice a day to keep the area soft will help. If you are doing this but your find that the hammer toes still show areas of friction causing pain, then you can use padding to the area. If your hammer toes are rigid and curling and rubbing up against the top of the shoe or the end of the shoe, then there are silicone toe caps that you can place on the end of the toes for protection. Again, if you find that these areas are not irritated to the point of a break in skin or an open sore, it is best to visit your podiatrist to make sure it does not become infected and she will provide a treatment plan to close that wound.
Sometimes the hammer toe itself may appear to be fine. However a hammer toe can cause pain in the base of the toe joint where the toe attaches to the long bone of the foot. When you walk, it may seem to be pain in the ball of your foot, however this ailment is actually in the joint, not in the toe. When the toe is contracted, it puts undue pressure on the joint itself, causing swelling and sometimes pain. This inflammation of the ligaments that form the capsule around the joint is called capsulitis. It mostly occurs in the 2nd digit, the toe next to the big toe, or hallux. It more frequently occurs in people with bunions, where the big toe is rubbing up against the 2nd digit but capsulitis can occur in any toe. As time goes on, the ligaments are weaker and the 2nd toe can become dislocated and this causes a hammer digit and even possible migration of the 2nd toe further on top of the joint or even to cross over to the next joint. So which came fist, the capsulitis or the hammer toe? It is difficult to say, but they often go hand in hand. To treat the inflammation of the toe joint, often conservatively padding and strapping to de-weight the joint will help relieve the inflammation. In conjunction with this, your doctor may recommend an oral inflammatory or MLS laser to decrease the inflammation. After ruling out a tear in the ligament, to decrease inflammation, a cortisone injection may be recommended. However if advanced testing shows a tear in the ligament, then surgical repair may be necessary in extreme cases that have been left untreated and progressed to the end stage. So if you do have hammer digits and feel that ball of foot pain, it is very important to see your podiatrist to help treat the hammer to and prevent its progression to a capsulitis.
The best thing you can do to treat your hammer digits is to address the cause of it in the first place. Hammer digits are due to intrinsic muscles in your foot that contract. If you can control the biomechanics of the foot and its internal musculature, you have a chance to reduce the progression of the hammer digits . The best way to do this is with custom orthotics. Our staff will place your foot in a biomechanically nautral position to take a total contact cast mold of your feet, then send these molds to the lab to construct custom inserts. These inserts are placed in your shoes so when you walk, your tendons, ligaments, and bones are biomechanically aligned to prevent undue stress. This way, your hammer toes contractures will receive less stress and less chances of worsening. It will not cure the hammer toes, but will certainly slow down its progression.
Sometimes after all conservative treatment of wider shoe box, padding, and orthotic have failed, the last resort would be surgery. Our practice will advise you of all your treatment options and will exhaust all conservative care before advising surgical correction. However if the hammer toe is at the end stages and has become a rigid bony deformity, then your doctor may discuss surgical options.
If you have hammer toes, rest assured there are ways to address them. If you are not sure if you have hammer toes, our doctors will help you determine your diagnosis and treatment plan. Remember that keeping healthy and active starts with your feet and your toes!