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Hammer Toe Specialist
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is Hammer Toe?
Hammer toe is a foot condition characterised by an abnormal bend in the middle joint (proximal interphalangeal joint) of a toe, typically affecting the second, third, or fourth toes. The joint bends upwards, causing the toe to resemble a hammer.
While hammer toe can occur in any of the smaller toes, it is most common in the second toe. If not addressed in its early stages, the toe may become permanently bent, potentially requiring surgical correction.
Causes of Hammer Toe
The development of hammer toe is often linked to an imbalance in the muscles, tendons, and ligaments that maintain the toe’s position. This imbalance leads to the abnormal bending of the toe. Several factors contribute to this:
- Ill-Fitting Footwear
Wearing shoes that are too tight, narrow, or have high heels can force the toes into a bent position. Over time, this position can become permanent as the muscles adapt to this unnatural alignment. Ill-fitting shoes may also increase pressure on the toe tendons and joints, potentially worsening the condition. - Chronic Pressure
Prolonged periods of pressure on the toes, such as from tight footwear, can lead to the formation of corns and calluses. These can aggravate the bending of the toe. - Certain Medical Conditions
Hammer toe may sometimes develop as a result of structural changes in the foot caused by other conditions, such as arthritis. These changes can affect the foot’s alignment and consequently the toe’s position. - Genetic Predisposition
Individuals with a family history of foot deformities may be more likely to develop this condition.
Symptoms and Signs
Common symptoms and signs of hammer toe include:
- Pain: One of the most common symptoms is pain in the affected toe, especially when wearing shoes. This discomfort arises from the unnatural bending of the toe, which can lead to increased pressure and friction inside the shoe.
- Swelling and Redness: The affected toe often exhibits signs of swelling or redness. This is typically a result of the constant pressure and rubbing against the inside of the shoe, leading to irritation and inflammation of the toe.
- Inability to Straighten the Toe: As the condition progresses, the affected individual may find it increasingly difficult to straighten the toe. In advanced stages, the toe may become rigid in its bent position.
- Difficulty in Walking: Hammer toe can impact an individual’s gait, leading to difficulty in walking.
- Formation of Corns and Calluses: A common side effect of hammer toe is the development of corns or calluses. These are areas of thickened skin that form as a protective response to repeated friction and pressure.
Diagnosis
The process of diagnosing hammer toe involves several steps:
- Physical Examination: During this examination, the foot specialist assesses the affected toe’s flexibility and overall foot structure. A rigid toe joint may indicate a more advanced stage of hammer toe.
- Evaluation of Symptoms: The foot specialist will consider the patient’s reported symptoms, such as pain, difficulty walking, and the presence of corns or calluses.
- X-ray Imaging: An X-ray may be conducted to visualise the bone structure and joint alignment of the toe. This helps in gaining a clearer understanding of the toe’s condition and to rule out other potential issues, such as arthritis or previous injuries.
Non-Surgical Treatment Options
In the early stages of hammer toe, when the joint is still flexible, various non-surgical treatments can be effective.
Changing to Appropriate Footwear |
Initially, the foot specialist may suggest changing shoes to those with a wide or deep toe box to reduce pressure on the toes. High heels should also be avoided. These changes can help alleviate pain and prevent the toe from bending further. |
Toe Splints and Orthotic Inserts |
These devices can help realign the toe and relieve pressure. Toe splints exert a straightening force on the toe muscles, preventing them from tightening in a curled position. Custom orthotic devices placed inside the shoe can also help in redistributing body weight across the foot. This reduces stress on the toes and provides pain relief. |
Physical Therapy for the Toes |
The foot specialist may also recommend physical therapy involving toe stretches. Exercises such as toe curls strengthen the foot muscles and improve flexibility, potentially correcting muscle imbalance. |
Anti-inflammatory Medications |
For severe pain or inflammation, anti-inflammatory drugs can be used to reduce discomfort. |
Surgical Treatment Options
If non-surgical treatments are not effective or if hammer toe becomes rigid or painful, surgical intervention may be considered.
Tendon Lengthening
This surgery targets the tendons that are responsible for the curled position of the toe. By lengthening these tendons, the toe can straighten out. This procedure is often suitable for less severe cases or when the deformity is still somewhat flexible.
Tendon Transfer
In this procedure, tendons from the bottom of the toe are rerouted to the top, to help balance the muscles responsible for the toe’s movement and to straighten a hammer toe. This is also ideal for flexible deformities.
Fusion
Fusion is often used for rigid hammer toe deformities. This procedure involves removing the joint surfaces and fusing the bones of the toe, typically using pins or screws. Fusion permanently stiffens the joint in a straightened, more functional position.
Prevention Strategies
A combination of lifestyle choices and an awareness of foot health can help reduce the risk of developing hammer toe.
- Wear Footwear with Enough Room for the Toes - Shoes should not be too tight or narrow and should provide adequate room for the toes. A half-inch of space beyond the longest toe and a deep toe box can reduce the risk of developing hammer toe.
- Avoid High-Heeled Shoes - Avoiding high heels and opting for low-heeled shoes can lessen the pressure on the toes.
- Engage in Foot Exercises - Specific exercises that stretch and strengthen the muscles in the foot can be effective in preventing hammer toe. These exercises include toe lifts, toe curls, and other movements that promote toe flexibility and strength.
- Avoiding Prolonged Pressure on the Toes - Being mindful of activities that put prolonged pressure on the toes can help in preventing the condition. This includes avoiding wearing tight shoes for extended periods.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
Insurance
Shield Plans
Corporate Partners
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can I Continue to Exercise with Hammer Toe?
Exercising with hammer toe requires some adjustments to ensure comfort and to prevent exacerbating the condition. Low-impact activities such as swimming, cycling, or yoga can be beneficial as they put less stress on the toes. Wear well-fitting, supportive shoes during exercise. Consult your foot specialist for exercise recommendations and modifications based on your condition.
What Happens if Hammer Toe is Left Untreated?
If hammer toe remains untreated, the condition can progress, leading to increased discomfort and potential complications. The toe may become rigid and fixed in its bent position, making non-surgical treatment less effective. This progression can impact daily activities and overall foot health. Seeking early treatment from a foot specialist can help prevent these complications and maintain foot function.
How Long Does a Hammer Toe Take to Heal?
The healing time for Hammer Toe varies depending on the treatment approach. Non-surgical treatments can provide relief over several weeks, whereas surgical recovery may take a few weeks to several months.