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John Schmelzel

Among the many injuries and deformities that can occur on our feet, hammertoes are among the most obvious. This condition causes the joints in the toes to contract, forcing the toes to bend upward at the joint.

“Anything that causes damage to the top extensor tendons, making them pull harder than they’re supposed to, can pull the toe back,” explains Dr. Lawrence Iken, a St. Louis podiatrist. In hammertoe patients, the tendons that attach to the top of the toe become contracted, sometimes to the point of becoming frozen in the abnormal position.

Hammertoes may be hereditary, and Iken says this is the case for the majority of patients. However, other factors can contribute to the problem. “This is a muscle tendon imbalance or the effect of overstabilization of the toes due to flat feet. When your feet are flat, you get used to over-flexing your toes for balance,” says Dr. Michael Horwitz, director of Feet for Life Podiatry Centers. “Cortisone shots given the wrong way also are a cause of hammertoe deformity. The tendons to the digits are delicate and can be injured if the practitioner is not knowledgeable and careful with injections.”

Hammertoes do not affect the big toe but may affect one or more of the other toes. As the toe contracts and is pulled up and back, it tends to rub on shoes, causing discomfort and calluses or corns. Patients often pad the corns and attempt to ignore the problem. “People like to buy over-the-counter medicines, and that’s a very bad thing to do,” Iken says. “It leads to a lot of complications as far as infections and problems of that nature. Unfortunately, an acid pad, as found in medicated corn pads, doesn’t know the difference between thickened skin and good skin. If you get it on the good skin, it’s like a first-degree chemical burn. So I would caution people not to buy medicated over-the-counter pads.”

People who have hammertoes should wear comfortable shoes with plenty of space for the toes. Tight or pointed shoes tend to exacerbate the condition. “Orthotics are good for slowing down the progression of the deformity; but even better, frequent use of minimalist footwear without orthotics will help keep your feet strong,” Horwitz says. He explains that hammertoes occur because of foot weakness and instability. “The stronger your foot is, the healthier it is. So if you wear orthotics, get out of them for at least 16 hours a week and get into minimalist footwear. This will strengthen your feet.”

Surgical correction is the only answer for some patients, particularly if the joints become rigid. The outpatient procedure involves cutting and realigning the tendons and also removing some small pieces of bone in order to straighten the toe. Iken says that most patients who have the surgery wear a surgical shoe for a couple of weeks and limit walking and standing initially as the toe heals. Most can resume all activities within a month.

“If you have a hereditary inclination to get hammertoes, use common sense with shoes and wear a comfortable shoe,” Iken adds. “And don’t let it get too bad. If you notice a malalignment of the toe and it’s starting to get contracted, see a podiatrist.”