Hammer toe • Causes & treatment of the misalignment

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Hammer toe is a common deformity where the middle joint of one toe is more bent and sticks up. If the hammer toe is only cosmetically disturbing at first, pain, pressure points and open wounds can develop later on – the toe should then be treated at the latest.

Woman massaging her toes

A hammer toe (hallux malleus, digitus malleus) is a misalignment of the little toes: the middle phalanx of the toe is bent upwards, while the end phalanx with the tip of the toe is in most cases inclined downwards. Specialists distinguish between the rigid (contract) and mobile (flexible) forms.

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Causes: how does a hammer toe develop?

In rare cases, hammer toes are congenital, but when they do, both feet are usually affected. In addition, the congenital hammer toe is already evident in infancy, when the children are not yet able to walk. The misalignment of the little toes usually develops over a longer period of time with increasing age. There are certain factors that favor an acquired hammer toe:

  • Incorrect footwear, such as shoes that are too small and tight or wearing high heels frequently

  • Malpositions of the foot, for example pes cavus, pes valgus, splayfoot or flatfoot

  • Other deformities of the toes, often hallux valgus (bunions)

  • Accidents and injuries to the feet

  • Neurological disorders such as paralysis that causes cramps (spasms) in the toes or Friedreich’s ataxia (an inherited disorder of the central nervous system)

  • Rheumatic diseases

  • Family history

  • Being overweight puts stress on your feet

  • Too little or one-sided movement

  • Tense and shortened muscles in shins and calves

Since in most cases unsuitable shoes are the reason for misaligned toes, flat shoes in which the foot has enough space can best prevent the development. High heels, on the other hand, should be worn as little as possible – walking barefoot a lot and doing foot exercises can compensate for this.

Symptoms of hammer toe

At first, a hammer toe often does not cause any discomfort, for many people the visible curvature of the toe is more of a cosmetic problem. In the further course, however, the malposition also becomes physically noticeable. For example, the shoes press on the curved toe joint, which often leads to the formation of calluses and corns. These can be very painful, which in turn can affect walking.

The more pronounced the flexion of the toe, the more difficult it is for patients to find suitable shoes. Due to the misalignment, previously worn shoes no longer fit – just as little as new shoes. All of this usually means psychological stress for those affected and can be very stressful.

Diagnosis can usually be made easily

A visual diagnosis is often sufficient to determine the hammer toe. If those affected also report pain and other complaints around the curved joint in the anamnesis interview, this confirms the suspicion. During the physical examination, the doctor will use the push-up test to check whether and in what form the toe can still be moved. To do this, she/he presses against the affected toe joint from below – with the flexible form, the curvature can still be compensated for, with the stiff hammer toe this is no longer possible. An x-ray may be taken to determine the extent of the curvature.

Treating hammer toe: from shoe inserts to surgery

A hammer toe will not go away on its own and will get worse without proper treatment. There are a number of conservative treatment measures – if these do not have the desired success, surgery can correct the hammer toe.

  • Shoe insoles: Individually fitting insoles can relieve the metatarsal and take pressure off the top of the hammer toe. The right place to go is an orthopedic specialist shop.

  • Rails: A splint can straighten the toe and hold it in the appropriate position. If you also have hallux valgus, you can use a hallux splint with a hammer toe loop.

  • Appropriate footwear: So that the feet have enough space and are not constricted, those affected should pay attention to wide shoes with a suitable toe box. In this way, further misalignments as well as pressure points and corns can usually be avoided.

  • Physiotherapy and toe exercises: In the physiotherapeutic practice, patients learn certain exercises that are intended to strengthen the muscles of the feet. A frequent component is that those affected should pick something up off the floor with their toes.

  • Hammer Toe Pillow: The small cushions are made of foam rubber, latex or silicone and are positioned under the hammer toe. They correct misaligned toes, provide relief and relieve pain.

Hammer toe surgery

If an operation is necessary, there are various techniques that are used depending on the type and severity of the hammer toe.

  • Shortening of the toe bone: In the Hohmann operation, bone substance is removed from the middle segment, thereby shortening the toe. The procedure changes the position of the toes and the misalignment is corrected.

  • Surgery according to Weil: The bone of the affected toe is severed (osteotomy) and shortened or moved as necessary. After the metatarsal head has been brought into the desired position with a saw cut, a titanium implant holds the bone there.

  • tendon displacement: This surgery can be used on flexible hammer toes. The extensor tendons are relocated and the flexor tendon of the affected muscle lengthened. As a result, the tendons exert less pressure on the bones.

  • PIP Arthrodesis: The surgeon removes the middle joint of the affected toe and inserts an implant that connects the remaining bones. This slightly shortens the hammer toe.

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