What Causes Hammer Toes and Claw Toes?
The most common toe deformities are hammer toes, claw toes, and bone spurs. These involve the lesser toes (2nd through 5th toes). In a hammer toe, the toe is bent at the middle knuckle of the toe, while in a claw toe the toe is bent at both the middle knuckle and tip of the toe. A bone spur can occur anywhere on the toes but most commonly affects the 4th and 5th toes. Each of the deformities can create corns on the toes and in more severe cases redness, swelling, and even an open sore can develop. It is important to note that the corns are not a skin problem! They develop because the skin is being crushed and irritated between the bones in your toes and your shoe.
You are usually born with the foot type that predisposes you to hammer and claw toes. People with flat feet, high-arched feet, or really flexible feet are more prone to develop these problems. Other causes are excessively long toes, tendon imbalance, injury, rheumatoid arthritis, and neuromuscular disease. Over time, the mechanics of your foot and shoe gear increases the deformities. Women are more frequently affected, probably because of the type of shoe they wear and the use of tight stockings.
What are the Symptoms?
The severity of the deformity may not correlate with the degree of pain. For example, a hammer toe or claw toe that looks severe may have no pain; while mild looking deformities may be incapacitating.
Pain and corns usually develop over the toes due to the friction of the shoe in that area. This rubbing of the shoe may cause a red, inflamed sac of tissue called bursitis. Initially, the deformities are flexible and can bet treated with simple measures but, if left untreated, they can become rigid or stiff and cannot be straightened. As time goes on, pain may develop deep in the toe joints and even the ball of the foot, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes and tight stockings will exacerbate these symptoms.
Hammer toes and claw toes are sometimes caused or made worse by a bunion deformity involving the big toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe or the second toe may be pushed upwards out of the way. This is one cause of hammer toes and claw toes.
What are the Treatment Options?
When hammer toes and claw toes are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe to allow room for the toes to move. This includes lower heels, softer leather, wider toe boxes, and gym shoes. Use of a pumice stone to thin any corns and callouses is sometimes helpful. Cushions and various soft pads may provide relief from shoe pressure over the toes. Never use a "medicated" corn pad since these contain a strong acid which does not know the difference between the bad and good skin and can lead to a chemical burn or deep open sore which can become infected.
When the hammer toes and claw toes are painful despite the conservative therapy options, or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of deformity that develops, and the more complicated the surgery becomes. Patients who have their symptomatic hammer toes and claw toes corrected earlier tend to have greater satisfaction after the procedure. When these treatment options are no longer providing the comfort you need, consultation with your podiatric physician is advised to discuss surgical options.
What Does Surgery Involve?
The goal of surgical correction is to restore normal alignment and function of the toe joint. If the toes are still flexible the tight tendons can be released and the toe straightened through a small poke-hole in the skin. If the toe is rigid, the knuckle is straightened and returned to a normal alignment. A small pin is sometimes placed inside the bones to hold the toe in proper position while it heals. The pin does not stick out the end of the toe and very rarely needs to be removed. If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint. If a bone spur is the cause of the problem this is filed down through a small poke-hole in the skin.
Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs, and in consultation with your surgeon.