What is a Hammertoe?
WHAT IS A HAMMERTOE?
Did you realize that each of the four smaller toes contains two distinct joints? Nature gives us these joints so that we have more flexibility within our toes. Unfortunately, along with this advantage comes a disadvantage, which is as follows:
Curl your toes downward. Now your toes are no longer straight; rather, they are buckled, or bent at the joints. There are many forces going through our feet as we walk. There are also many muscles, some of which attach to our toes. In order for our toes to remain straight, the forces and pull of our muscles must remain well balanced. Often, abnormal forces going through our feet allow some of the muscles to gain an advantage over other muscles. This usually occurs slowly but surely over a long period of time. When this occurs, it is no longer possible to uncurl our toes. The curling becomes permanent. This curled toe is referred to as a hammertoe.
A hammertoe is a deformity of any of the five toes, but most often one of the four smaller toes. Note that the first bone of the toe is angled upward, and the last two bones are angled downward. The apex (top) of the hammertoe is subject to shoe pressure, which will eventually create a corn (abnormally thick skin), causing the unfortunate recipient to require a shoe with a higher toe box.
Look again at your curled toe. You can see that the knuckle (the joint) has become much more prominent. Now it will be much more prone to irritation from the top of your shoe. Over a long period of time, this constant irritation leads to changes in the skin overlying the joint. The skin becomes thicker, which is the body’s way of protecting itself. This thick skin is called a corn. Sometimes a corn also develops on the tip of the hammertoe because the curled toe now forces the end of the toe to rub against the ground (or the bottom of the shoe).
Four other consequences sometimes occur due to a hammertoe:
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If too much irritation occurs to the top of the knuckle over a short period of time, you may develop an ulceration (raw sore) in the skin.
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A tiny bursa sac may develop between the bone and skin. When the bursa sac becomes inflamed, it causes ?ouch!?bursitis.
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A small hole may develop in the top of the corn. This hole is called a sinus tract, and can be dangerous because it goes below the surface of the skin and may become infected.
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If the toe becomes extremely bent, it may increase the tendency to form a callous on the ball (bottom) of your foot.
Treatment falls into two main categories, conservative therapy and surgery (to straighten the toe). Conservative therapy varies according to the nature of the problem, but may include a change in shoe style and size (to decrease pressure on the toes), padding, debridement (your podiatrist can scrape off some of the dead tissue if you have a corn), injection, and molded shoes.
The decision of whether to have your toe surgically straightened will depend on such factors as your age, health, circulation, activity, the severity of your hammertoe, and whether or not you obtain relief from conservative therapy. In any case, do NOT try to treat yourself with either acids (corn remover) or razor blades, especially if you have diabetes or poor circulation. Your health is too valuable to take the risk of making things worse by causing an infection or accidentally cutting yourself.
Dr. Goldstein has been running for many years--without suffering from hammertoes. He is Board Certified in Podiatric Surgery, in Podiatric Orthopedics, and also in Podiatric Medicine.