Hammertoe deformity occurs when the toe is bent at the proximal interphalangeal joint (PIP), which is the middle joint of the second through fifth toes. This deformity causes the middle knuckle to rub against the top of a person's shoes. Depending on the stage of hammertoes, there are various orthotic non-surgical and surgical options to reduce pain and accompanying limitations.
Better Footwear
In the earlier stages of hammertoe, the deformity is still flexible, meaning the toe can be straightened and has not become fixed in that position. Wearing better shoes may help the toe straighten and can help to prevent corns from developing on the PIP joint. You should choose shoes that are not pointed or otherwise narrow in the toe box, since this forces the foot to assume an unnatural shape, thereby encouraging deformities. Rounded or square toe boxes are the most accommodating for the natural contours of the foot.
It is important to wear shoes in the appropriate size. When the toes are pressed against the end of the shoe, it is natural for them to bend at the PIP joint. It is generally recommended to measure your feet late in the day since they are usually larger at that point. If you have many issues with your feet, you may also consider having varying sizes since swelling can drastically change your shoe size from day to day. Choosing shoes made with a soft material can allow your shoes to be more accommodating, regardless of swelling or other issues. Shoes with a deeper toe box will also prevent the PIP joint from rubbing against the top of the shoe, which would cause pain and eventually a corn.
Physical Therapy And Orthotics
Your doctor or a physical therapist may recommend specific exercises and orthotics to reduce muscle imbalances that cause hammertoes. These are only appropriate for deformities that are not fixed. You can work on straightening and bending the affected toe. If you cannot bend and straighten it on your own, you can use your hands to passively manipulate the joint. Another type of exercise that can be helpful is using your toes to pick up objects, such as a marble or another object that you can grasp with your toes. Doing these exercises regularly can help strengthen the muscles that are responsible for the deformity. Orthotics that keep the toe straight can also prevent the deformity from becoming fixed.
Surgery
The appropriate procedure will be contingent upon the exact problem and whether your PIP joint has become fixed. Manipulating the tendon in the toe may help deformities that have not become fixed. Your surgeon may either replace the tendon or lengthen it so the toe no longer remains in the bent position. If the toe has become fixed, it may be necessary to fuse the joint. This is accomplished by removing the PIP joint and using pins to keep the toe straightened. Once the joint has healed, the pin can be removed. Although the joint will no longer have movement, it may relieve pain and make it easier to walk.
The treatment approach to hammertoe deformity will depend on how much the problem causes pain or interferes with your ability to walk, and whether the deformity is fixed. If treated early, it is possible to avoid surgery and reduce the progression of the deformity.