Hammertoes can affect all ten toes. Depending on which toe joints are affected and how these may also be called mallet toes and claw toes. Hammer toe is a general all-encompassing term for contracted toes which are not straight.

These can be caused by mechanical imbalance between the muscles and tendons on the top of the feet and toes and the muscles and tendons on the bottom of the feet and toes. Due to the off axis anatomical pull of the tendons to the 5^th toe some inward curl of the 5th toe is quite common. This is a progressive condition, and as the joints adapt to being in a contracted position the deformity becomes stiff and rigid.

Bunion and tailors bunion / bunionette deformities are frequent causes of hammertoes. Connective tissue disorders such as RA, DM, EDS can also result in contracture of the toes. Genetic alignment of the foot bones is also a contributing factor.

Treatment:
While shoes DO NOT cause hammertoes, they do make them more symptomatic. Tight shoes can cause painful impingement on the toes, calluses, redness and irritation, and even open sores. At a minimum, wide shoes, or shoes with an anatomic foot shape, where they are wider and boxier in the forefoot are recommended. Shoes with a stretchy upper and increased depth (vertical room for the toes) are also helpful. Shoe inserts and custom orthotics can help with pain on the bottom of the foot. Toe pads, toe splints, and toe socks can sometimes help with pain and are generally worth a try. Stay away from splints with rigid components as these are generally painful to use and cannot be worn with shoes.  Foot exercises may be helpful if one is diligent in doing them. Rest, ice, and pain medication such as NSAIDs or acetaminophen can also be helpful in managing pain.

While the toes are flexible, they are more amenable to digital splints, padding, toe socks, and toe exercises.  Once the joint contracture is stiff and not reducible conservative treatment is limited to some types of padding and shoes with enough room for the toes. Surgical hammertoe correction can be helpful if conservative care does not provide adequate relief.

If you are having significant pain and discomfort, your symptoms are limiting physical activity, or affecting your quality of life, schedule an appointment now for an evaluation and discussion of your feet and treatment options.