A hammertoe is a general name for a toe that is bent. Hammertoes are caused by genetics, arthritis, poor-fitting shoes, or feet that are either excessively high-arched or flat. You can’t change genetics, and in most cases, you can’t prevent arthritis. You can, however, wear shoes that fit well (that don’t crowd the toes and are more boxy than pointed).
Rule #1: If it doesn’t hurt, don’t fix it! You can go your whole life with a bent toe that never hurts.
Rule #2: If only certain shoes hurt the toe, don’t wear those shoes.
Rule #3: If you don’t like the way it looks, you can decide if it should be fixed. Surgery can be done, but you have to weigh the recovery against how willing you are to let it heal correctly. If this seems like a lot to go through, it’s better to wait.
Rule #4: If it hurts and/or limits you, get it fixed. Surgery takes about 15 minutes. Depending on the degree of deformity, the recovery may take three to eight weeks. For the first three days, you must minimize activity to keep the swelling down. Between day three and 14, you will need to limit standing and walking, and plan on keeping the foot elevated. You cannot get the foot wet for 11-14 days while the stitches are in. If the deformity is significant, the joint may need to be fused. This means a pin needs to stay in the toe for 3-6 weeks, which means a longer recovery. If there is no pin, you can usually wear shoes in 2-4 weeks and return to sports in 4-6 weeks.
If you have high-arched or flat feet, you may be able to slow or stop the progression of hammertoe deformities. Think of the toes as straight hinges balanced on the top and bottom by tendons. If your arch is high, there can be a steep drop off in the front of the foot. That will create more tension on the tendons that pull the toes up. When that occurs, the tendons on the bottom respond by pulling down. This “tug of war” then causes the toes to buckle at the hinges, forming what are called hammertoes. Conversely, a flat foot causes the tendons that come down the leg, into the arch and towards the toes, to pull on the toes. This pull is in an angle from the arch towards your little toes. Again, as the tendons on one side of the toe pull one way, the tendons on the top try to pull the other way, causing bending at the hinges or hammertoes. In some cases, putting orthotics (arch supports) in your shoes may slow or stop the progression of your hammertoe deformities.
See a podiatrist for an evaluation or go to your local sports store and try some over-the-counter orthotics first. Make sure these aren’t too bulky, which would causing your shoe to be tighter and more uncomfortable against your hammertoes.
More on hammer toes
Contributed by Gene Mirkin, DPM