Hammertoes
What are Hammertoes?
Hammertoes are one of the most common foot disorders, and are produced by a muscle imbalance in the foot, which causes the end of the toe to bend down while the closer or more proximal part of the toe bends up. More often than not, the joints may stiffen permanently in this awkward position. Hammertoes can be inherited, caused by a nerve abnormality or abnormally tight hose, socks or shoes. When the crooked toes rub up against the shoes, painful corns may develop. If not treated properly, pain will persist. Redness, swelling and infection will consequently develop.
Dr. Michaels Says:
“Hammertoes can be caused by a number of things, but are mostly attributed to improper balance of the muscles and tendons in the foot or chronic use of inappropriate footwear (shoes that are too small or frequent use of flats and high heels),” Dr. Michaels says. “They will usually begin as a reducible deformity, meaning when you push down, the toe will lay flat. But left untreated, they will become rigid and will require more aggressive treatment, Dr. Michaels says.”
Hammertoe Treatment Options
Conservative treatment includes square, open-toed, high-toe-boxed or prescription shoes. Orthotics are foot beds that help support the foot and can reduce the hammertoe deformity. Other measures include cushioning of the pressure spots with adhesive donut-shaped pads or other forms of padding. The best conservative treatment is a gel toe crest pad and this pad is available at our offices for your relief. It simply slips on your 2nd or 3rd toe and straightens out all your toes. It is not advisable to remove corns or calluses yourself as this “bathroom surgery” can lead to infection. If the corns continually grow back and pain persists, surgery may be required.
There are several different types of surgery for these problems. Often if conservative treatment doesn’t solve the problem then a tenotomy/capsulotomy can be performed to straighten the toe. This is a procedure that allows you to walk the same day, have the surgery in the office and requires no time off work. You will have your toe anesthetized with a small amount of anesthetic and the tendon (s) and or capsule on the bottom of the toe is cut. This will immediately straighten your toe and relieve the problem if it is a flexible deformity. If it a rigid deformity it may help to a point and it may be enough to avoid having a joint cut out of your toe. Consider a foot with a high arch and over decades, gravity’s pull causes the ligaments in the foot to give a bit and the arch collapses. The foot gets larger because it is collapsing as the bones are less of an arch and are straighter caused by the ligaments giving out. What does not stretch is the tendon to each of your toes. They are like steel cables and as your foot gets larger or longer then they pull more and cause your toes to hammer. Releasing one or more tendon (s) in your toe as well as a joint capsule often helps this. The neat thing about this procedure is that it heals very quickly and here is no time off work or school. You will not be able to curl your toe again as the tendons that do this are cut but the relief you get in a short amount of time is worth this in most cases.
If your toe is crooked and can’t be straightened the tenotomy can still be performed but the results may not be as great as if the deformity was flexible. In cases where bone is the cause of the toe the surgery consists of the flattening and straightening of the affected toes by removing a piece of bone and/or lengthening of the shortened tendon. Fusing one of the joints in the toe may be beneficial for you as well. Sometimes one of the metatarsal bones has to be shortened to fix your toe and this requires bone healing and 6 weeks in a special wedge shoe. As in all surgery, your recovery period depends on the severity of the deformity, your age and the type of work that you do. The surgery is usually 10 minutes long and is done as an outpatient with no overnight stay in the hospital. You can go to sleep or stay awake for the procedure. Most patients have little or no pain, walk that day and take minimal time off work.
This patient had a release of her hammertoes on the left foot by releasing the plantar flexor tendons and capsule to the interphalangeal joint done in the office. See how the left foot toes are straighter than the right foot. We release one toe at a time and this allows us to better rebalance your foot over time. You can have hammertoes fixed and walk out in your own shoes and drive home the same day. There is no downtime and insurance covers the procedure. Interphalangeal joint capsulotomy is the new way to repair your hammertoe as the old way required bone excision and wire or screw placement done at a hospital or surgery center. After the procedure, people report being able to walk better as their toes are flat to the ground and not curled. This helps with ambulation and balance. This patient wanted her left foot done first as it was worse than her right foot.
This patient has had plantar IPJ Capsulotomy procedures done on the toes 2,3,4 right and 2,3 left. Note the curled toe 4,5 left and 5 right. These will need to be done but you can appreciate the straight nature of the toes that have had releases done and the curled posture of the toes that need to be done still. This procedure is done in the office and you can walk and drive home that day with no or minimal post-op pain. We typically do one toe per week as we are balancing out the foot. This also decreases the chance for infection and other complications as the patient only has to deal with one wound at a time. 
This is a hallux hammertoe deformity. Note the thick nail on the medial (inside) of the toe with the associated callus on the skin. The callus and the thick nail are from the patient curling the toe when they walk excessively, and the extra pressure causes the damage to the nail and skin. A simple procedure to release the interphalangeal joint can solve this. This procedure is done after the patient has exhausted conservative treatment like gel toe caps, gel toe rings, gel toe crest pads and better shoes with anterior rocker soles. These types of shoes are made by Hoka and Gravity Defy (Gdefy). The release procedure is done in the office and there is no pain, and the patient can walk out and they heal in about a day or two. There is no time off school or work.
