Today, I'd like to discuss a common condition known as hammer toe. We'll explore its causes and treatment options and answer some frequently asked questions to provide you with a thorough understanding of this condition.
Hammer toe is a deformity that causes one or more of your toe joints to bend upward instead of lying flat.
Hammer toe affects the second, third, or fourth toe results from an imbalance in the muscles, tendons, and ligaments responsible for maintaining toe alignment. If left untreated, the affected toe may progress from being flexible to rigid, leading to increased pain and difficulty walking.
The forefoot consists of five toes, each playing a crucial role in balance and movement.
Structurally, four of these toes have three joints: the metatarsophalangeal (MTP) joint at the base, the proximal interphalangeal (PIP) joint in the middle, and the distal interphalangeal (DIP) joint near the tip. However, the first toe, commonly known as the big toe, differs from the others as it has only two joints, the MTP and the interphalangeal (IP) joint.
In cases of hammer toe, the deformity primarily affects the PIP joint, causing it to bend abnormally while the other joints may remain straight or become misaligned over time.
This condition often results from wearing ill-fitting shoes that force the toes into a bent position over extended periods.
As mentioned, hammer toe is the result of a soft tissue imbalance that puts pressure on the toe muscles, tendons and joints.
High heels or shoes that are too tight can force the foot down and push the toes against the shoe, increasing the pressure and the bend in the toe. If the toe is bent into one position of long enough, the muscles and joints begin to tighten and cannot be stretched out.
Additionally, certain medical conditions like rheumatoid arthritis or diabetes can increase the risk of developing hammer toes due to joint damage or nerve issues.
Hammer toe presents with several noticeable symptoms that can worsen over time.
Initially, you may experience mild discomfort and some hard skin developing on the toes, but as the condition progresses, symptoms can include:
Early recognition of these symptoms will help to ensure effective treatment and prevent longer-term complications.
A clinical examination is the first step in diagnosing hammer toe. When you come into the clinic, I will assess your foot’s structure, flexibility, pain levels and mobility.
Imaging studies may be necessary for a more detailed evaluation:
It is very important to get an accurate and early diagnosis so that we can give you the most appropriate treatment for your specific symptoms and goals.
Yes, hammer toes can be corrected. This can be done surgically or using non-surgical interventions depending on the severity.
Your symptoms and the flexibility of the affected toe play a significant role in determining the best and most effective treatment for you.
In the initial stages, mild hammer toe can be treated with non-surgical interventions when the toe is still flexible.
These may include:
These methods aim to alleviate symptoms and help prevent further progression of the deformity but are unlikely to correct the condition.
Unfortunately, if the toe has already become rigid then surgical intervention might be necessary to correct the deformity and to give you the best outcome in terms of pain relive, improved mobility and quality of life.
Hammer toe straighteners, such as splints or toe caps, can provide relief, especially in the condition's early stages. These devices help in:
It's important to note that while these devices can alleviate symptoms and provide temporary correction, they may not offer a permanent solution, particularly if the toe has become rigid.
Podiatrists employ a range of treatments based on the severity of the hammer toe. Initial approaches often involve:
Your treatment will depend on an individual assessment and the progression of the deformity.
I work closely with expert podiatrists to provide a holistic and multidisciplinary approach to your treatment and care.
Surgical intervention may be necessary for patients with persistent or severe hammer toe.
Each surgical approach aims to relieve pain, improve toe function, and prevent any further complications.
The choice of procedure depends on whether the toe joint remains flexible or has become rigid.
It is then secured with an external K-wire or pin, which holds the bones in place while they fuse together.
Advancements in medical technology have introduced innovative surgical treatments.
Instead of temporarily holding the operated toe in the corrected position with a pin, an internal implant can be used, which does not have to be removed. In certain situations, these implants are very beneficial.
Additionally, minimally invasive surgical techniques have been developed to correct hammer toes with smaller incisions, reducing recovery time and postoperative discomfort.
Deciding on whether to have surgery depends on several factors:
Surgical correction can offer long-lasting relief, improved toe function and better mobility, but I will always ensure that all the options are discussed, and we will make an informed decision together.
Post-operation hammer toe surgery, second toe on the right foot (left side of photo). The mild hammer toe on the other foot is being treated conservatively at present.
Hammer toe surgery is typically performed as a day case, so you are only in the hospital for a few hours and don’t usually stay overnight. The surgery is often performed under local anaesthetic rather than a general anaesthetic, although this will be discussed individually. You will not feel any pain during the procedure.
Postoperative discomfort varies among individuals, but we ensure that you receive the appropriate medication so you do not have pain.
You can weight bear after the operation and do not need crutches, but as hammertoe operations are often associated with after-forefoot operations, you might need to wear a stiff-soled post-op shoe to protect the operated foot.
It’s important that you follow the postoperative care instructions given to you, to ensure a smooth recovery.
Recovery from hammer toe surgery varies based on the procedure performed. Initial skin healing from the surgery takes approximately 10-14 days.
Here are some guidelines to recovery timeframes:
Long-term outcomes are generally positive, and most patients experience significant pain relief and improved toe alignment and mobility.
Hammer toes are a common foot condition that can cause discomfort and affect daily activities. Early recognition and intervention are key to managing symptoms effectively and potentially avoiding surgery.
Whether through lifestyle modifications, non-surgical treatments, or surgical options, I will ensure that you receive a tailored approach to help you restore function and improve your quality of life.
Mr Martin Klinke is one of London’s most trusted, and experienced foot specialists. He performs many bunion surgeries each year, and is a highly skilled surgeon.
He offers this surgical treatment to private self-funded and insured patients at London Bridge Hospital, BUPA Cromwell, and New Victoria Hospital. He also runs outpatient clinics at Chiswick Outpatient & Diagnostic Centre, The Shard, Canary Wharf and One Welbeck.
You can find all his patient reviews here.
