Pediatric Orthopedic Surgeons treating a Hammer Toe

HAMMER TOE

A hammer toe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, so that it resembles a hammer. Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed and require surgery.

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Hammer Toe

A hammer toe is a disorder that disturbs the second, third, or fourth toe. The toe’s middle joint, which bends down and looks like a hammer, is impacted. A structural imbalance in the areas around the joint is the cause of the disorder. Wearing shoes that don’t fit properly is a typical contributing factor. Pain, edema, and trouble walking are among the symptoms. When it first begins to form, a hammer toe might bend. However, it might grow inflexible if a child with the condition is not treated.

What Distinguishes Mallet, Hammer, and Claw Toes from Each Other?

A foot has 28 bones. The first (or “big” toe”) of your five toes contains three joints: the interphalangeal joint and the metatarsophalangeal joint and the distal phalangeal joint, which is closest to the tip of your toenail, and one of the joints that the other four toes have.

A hammer toe has a strange bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammer toe and mallet toe usually occur in your second, third, and fourth toes. Relieving the pain and pressure of a hammer toe and mallet toe may involve changing footwear and wearing shoe inserts.

What are the Types of Hammer Toes?

Hammer toes can be of three different types:

Flexible hammer toes

The flexible hammer toe is still developing, so the affected toe can still move the joint.

Semi-rigid

The hammer toe is becoming more rigid.

Rigid hammer toes

The tendons and soft tissues have tightened, making a rigid hammer toe immobile.

Symptoms and Diagnosis

A person who has a hammer toe will always have one of their toes bent. They can find it challenging to straighten it or they might even fail to do so. Other hammer toe signs and symptoms include:

  • The injured toe feels painful, especially while moving or wearing shoes.
  • The middle joint of the hammer toe has a callus or corn on top of it.
  • Swelling

Difficulty walking

To determine if the toe can straighten out or is inflexible, the diagnosis entails a physical examination. Doctors will request an X-ray to confirm a hammer toe if they have any doubts. A doctor may also request testing for the nerves and muscles in the feet if it appears that another disorder, such as diabetes, may be having an impact on those areas.

What Causes Hammer Toes?

A hammer toe grows when there is an imbalance in the muscles of your toe that causes strain on the tendon and joints. The following issues contribute to imbalanced muscles:

  • Genes: Your child may be more likely to develop this kind of joint deformity depending on the type of foot he or she was born with. Hammer toes can develop as a result of flat feet trying to balance themselves against a flattening arch. Because the extensor tendons outnumber the flexors, high-arched feet are also susceptible to developing hammer toes.
  • Poor shoes: Poorly fitting footwear offering little to no arch support can contribute to children getting hammer toes.
  • Neuromuscular disease: Diseases of the neuromuscular system can cause hammer toes. Diabetes patients may have a higher risk of complications. Toes with corns or other ulcerations are a sign of excessive strain on the toes. People with diabetes who suffer from neuropathy or poor blood circulation may lose a toe or a portion of their foot if infected corns and lesions are not addressed.
  • Trauma: Rarely, does a toe injury cause a hammer toe.

How to Treat Hammer Toes

The toe is still elastic in the beginning stages of the hammer toe. During this time, non-surgical approaches can prevent the toes from getting stuck in a bent position. Our doctors may recommend:

Footwear changes

Children should avoid wearing narrow, or tight shoes if they have an early-stage hammer toe. Parents should get their children the following:

  • Shoes with a heel no higher than 1 inch must be flat or low-heeled.
  • Large, deep toe boxes in the shoes to accommodate long or bent toes
  • Sandals or open-toed shoes.

Exercises

In addition to strengthening and stretching the muscles in the foot, exercises may also help to correct the imbalance that causes a hammer toe. Exercises in particular include:

  • Using the toes to pick up small items like marbles.
  • Squishing a towel with the toes on the floor.
  • Hand massages that softly extend the toe.

Over-the-Counter Products

To maintain toes in a comfortable posture and lessen the strain on them, parents might purchase foot aids at the local pharmacy for their child. This could consist of padded straps, tubes, or cushions. Corn or callus cushions can help lessen pain. Parents may consider their child an over-the-counter pain reliever to treat their pain.

Splint

A splint is a type of brace that can help reduce the symptoms of a hammer toe or prevent it from getting worse. Inserting splints into your child’s shoes can help control imbalances in muscles, tendons, or both. You can get a brace specifically for your child’s foot as well. Our surgeons may also recommend it for use after a child has had surgery.

Surgical Treatment

Pain is the main justification for surgery. A mild to moderate case of hammer toes is one that is flexible and doesn’t hurt. When severe abnormalities are permanent, immovable, and painful, surgery is performed. Surgery is a possibility if nonsurgical therapy fails to relieve symptoms or the hammer toe becomes immobile. The majority of the time, hammer toe surgery just involves local anesthesia and does not necessitate a hospital stay. The forms of surgery available are:

  • Tendon lengthening: This is an option for children who have a hammer toe that is still flexible rather than fixed. It lengthens the tendons that are the source of the imbalance.
  • Tendon transfer: Another procedure for those with a flexible hammer toe includes moving tendons from the toe’s bottom to its top in order to straighten the joint.
  • Arthrodesis: This surgery is for stiff malleus and involves immobilization of the joint. During surgery, the surgeon removes a small piece of bone in the joint so that the joint is perfectly straight. Our doctor may be able to combine this with tendon lengthening.

Current Surgical Techniques

A current successful surgical method involves permanently implanting rods and screws in the toe. These don’t protrude and aren’t taken off. The toe will remain stable and in a secure position, even if you stub your toe or damage your foot later on. Surgery is performed under little sedation in an outpatient environment. For four to six weeks after surgery, your child will wear a special shoe as he or she may not be able to wear the majority of their shoes for eight to 12 weeks. Eighty to ninety percent of the time, surgery is successful, and complications are rare. There might be a little pain. The most typical issue is toe stiffness and edema, which can linger for several months. About 1 to 3% of patients experience discomfort or a loosening of the fixation device.

About 5 to 10% of patients who had surgery on their hammer toe develop it again in another toe. The middle joint of the toe is typically the site of hammer toe surgery. Underneath the toenail, another joint has the potential to distort. Or the toe directly above it could become unstable and vulnerable to developing a hammer toe.

Surgery Recovery

A person who has undergone one of these surgeries must restrict their usage of their feet while the toe recovers. Pain or swelling may last for 4-6 weeks in some people. The healing process may need to start with 2–6 weeks of limited weight-bearing activity in special shoes before switching to a rigid sports shoe. People with specific diseases, such as diabetes, may experience a slower recovery. PIP joint fusion is the most often performed surgical treatment for hammer toes. The two bones are permanently fused together, straightening and stabilizing the toe.

 

If you Have Many Toes Affected by Hammer Toe

Both numerous hammer toes and a bunion are typical foot deformities. The big toe bends toward the second toe when a person has a bunion. A hammer toe may develop over time as a result of the strain this places on the second toe. Often, one operation can treat both a bunion and many hammer toes. Doctors can operate on many toes at once, but they typically only treat one foot at a time. The techniques could change if more than one toe needs surgery. For a hammer toe, you could have a PIP joint fusion, and for a bunion, another treatment. A treatment to cut and shorten the bones or to realign the ligaments and tendons around the base of the toe are additional options, but bunions in children are rare.

Less Invasive Options for Hammer Toe

For hammer toes, less intrusive surgical techniques are being created. It is becoming more popular to cut the bone utilizing minimally invasive techniques (smaller incisions). Additionally, some foot and ankle surgeons focus on the soft tissue rather than cutting the bone. Tenotomy is a technique that includes severing the tendon. The verdict on the long-term impacts has not been determined. Currently, soft tissue surgeries are performed on children who have more flexible deformities, modest deformities, or who have medical issues that make surgery dangerous.

Outlook

Overall, hammer toe has a bright future. The best chance of stopping the progression of hammer toe is through early therapy, although outcomes following surgery are very promising. 90% of people won’t experience a recurrence. To get a diagnosis for this frequent disease, patients can call our office and make an appointment to talk to one of our orthopedic doctors who specialize in children.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four convenient locations: Arlington, Dallas, Frisco and McKinney.