Hammer toe and claw toe are misalignments of the toe joints, visible through the curvature of one or more toes. The hammer toe (claw toe) can initially be corrected using conservative methods, but in an advanced stage it can only be corrected using surgical measures.
What is a hammer toe (claw toe)?
The most painful deformations of individual toes are known as hammer toes or claw toes. These malpositions can be recognized by the curvature of the toe joints.
One speaks of a hammer toe when the end joint of the toe is bent when the base joint is extended. If you suffer from a claw toe, the middle or end joint is curved, while the metatarsophalangeal joint is hyperextended.
Both toe malpositions can be diagnosed relatively often, with the hammer toe predominating. It is often the case that, in addition to the abnormal development of a hammer toe or claw toe, a deformity of the big toe can also be observed. This is referred to as the ” hallux valgus “.
What are the causes for the pathological development of a hammer toe or claw toe? Wearing shoes with heels that are too high or shoes that are too tight is responsible for this. The toes don’t have enough space. They hit the toes of the shoes and can therefore gradually become crooked.
Since the toe musculature is hardly moved these days – mainly because the foot usually remains wedged in orthopedically unsuitable shoes all day – it atrophies and the development of a hammer toe or claw toe is only a matter of time.
However, a malposition of the foot such as splayfoot, flatfoot or splayfoot can also promote the development of hammer toe and claw toe.
Neurological diseases and muscle or nerve injuries to the foot or lower leg can also be the cause. Rarely, genetic factors are responsible for hammer toe or claw toe.
Symptoms, Ailments & Signs
The hammer toe or claw toe has a distinctive appearance. The main symptom is a typical toe misalignment, in which the middle toe is overextended and the end of the toe is pointing down. The shape of the toe thus resembles that of a hammer. The difference between a hammer toe and a claw toe is that the tip of the toe touches the ground. In many sufferers, more than one toe of the foot is affected by a deformity.
In many cases, those affected are symptom-free apart from purely cosmetic aspects. For others, the malposition of the toes causes instability, which can lead to pathological stress on the foot. This is especially the case when several toes of the foot are deformed. This can lead to pressure points and severe pain.
In advanced stages, there is further deformation of the hammer toe or claw toe. The pain increases over time. The affected toe continues to shorten and at the same time requires more space in height. Wearing shoes that are too tight can lead to the development of corns or painful calluses.
The hammer toe, or claw toe, develops relatively inconspicuously at first: One day you notice a small bump on one or more toes. If you fail to visit the orthopedist in time, the small bony changes will gradually result in unsightly humps.
The toe deforms more and more, the middle or end joint bends and hits the shoe cover. The result: Pressure points on the toe make walking a painful ordeal. Corns develop, which can easily become inflamed and cause infections from constant rubbing on the shoe.
Diabetics are particularly at risk due to the extreme sensitivity of their feet. Failure to treat the hammer toe (claw toe) in a timely manner can result in complete crippling and stiffening.
The hammer toe causes various complaints and malformations on the toes. The further course of the disease usually depends heavily on the exact complaints and symptoms. In most cases, however, the patient is late in diagnosing the disease himself. The reason for this is that the symptoms are initially only inconspicuous and cannot be attributed to the hammer toe.
Symptoms and changes in the bones only appear later on. The toes become crooked and this can lead to severe pain. These occur mainly when running and can lead to restricted mobility. It is not uncommon for so-called corns to occur.
Furthermore, the affected person can easily develop inflammation and infections on the toes. The feet are particularly sensitive due to the disease. The treatment of hammer toe usually depends on its severity. In many cases no surgical intervention is necessary. There are no further complications. The symptoms can be alleviated by various insoles, therapies or implants. Life expectancy is not limited by the hammer toe.
When should you go to the doctor?
A hammer toe does not always cause symptoms and usually does not require treatment. However, if pain or other misalignments occur, a doctor’s visit is recommended. If pressure sores and corns occur in connection with a claw toe, orthopedic measures must be taken. Infections, bleeding and other complications also require rapid clarification and treatment by a specialist. Diabetics are particularly prone to hammer toe.
If the first signs of a misalignment are noticed, the doctor responsible should be informed. Hammer toes are also more common in people who suffer from splayfoot, flatfoot or pes knots. Other risk factors include tight or improper shoes, neurological disorders, and muscle or nerve injuries.
Anyone who belongs to this risk group should have the first symptoms clarified immediately and, in the event of acute symptoms, visit a doctor’s office in the next few days. Should ulcers or infections develop as a result of the hammer toe, it must be treated immediately, otherwise the symptoms can become severe.
Treatment & Therapy
If the deformity of the hammer toe or claw toe is not yet pronounced, conservative, i.e. non-surgical treatment is advisable. For example, the orthopaedist prescribes special shoe inserts or night splints that are intended to stretch the toe overnight.
He prescribes toe exercises at the physiotherapist. It is also essential to wear comfortable shoes made of soft leather. The pressure points can also be relieved with special pads. Regular visits to the podiatrist are also recommended. Here the treatment of the corns is in the foreground.
However, the deformity of the hammer toe (claw toe) cannot usually be reversed with conservative therapy. For more severe deformations, only surgery can help. There are several ways to eliminate the curvature of the toe: The surgeon inserts an implant such as the SMART TOE®, a newer and quite successful method in the affected toe.
Although this stiffens the toe joint, it stretches it and returns it to its original shape. Another method is to remove the affected bone while rebuilding the tendons and muscles. Hammer toe or claw toe surgery is usually performed on an outpatient basis under local anesthesia.
Outlook & Forecast
The prognosis of a hammer toe depends on the extent of the deformity and the age of the patient. If the affected person is still in the growth and development phase, corrections can be made by wearing shoes or by special exercises of the limbs. If the hammer toe is only slightly pronounced, the prognosis for the patient is good. In many cases, healing can be achieved within a few months if all the guidelines are successfully implemented.
With the completion of the growth phase, the prospect of a full correction usually worsens. Nevertheless, significant improvements can be achieved with orthopedic measures and individual gymnastics of the toes.
If there is a severe malformation of the toes, a correction can only lead to an alleviation of the existing symptoms by means of a surgical intervention. If the operation is carried out without further complications, an improvement in the quality of life is achieved in most cases. Freedom from symptoms is rarely possible, but not impossible.
The later medical care is initiated and the more severe the malformation, the less favorable the prognosis for the patient. In severe cases, a progressive course of the disease can be expected or the toe and ankle joints have to be stiffened. This prevents an increase in discomfort along the foot or leg.
To prevent the hammer toe or claw toe from developing in the first place, the following preventive measures should be taken: Comfortable, not too tight shoes with heels not exceeding three centimeters are particularly important. Regular toe exercises are also helpful.
When walking, you should make sure that your feet roll off correctly – so don’t claw your toes. If you consistently pay attention to the health of your feet, you don’t have to worry about suffering from hammer or claw toes.
During the surgical correction of hammer toes, joints, tendons and bones are affected. In order for the toe to remain in the desired position, it is fixed with tape bandages or a splint and wires. The tape associations must be checked regularly and renewed if necessary. Wires are usually removed after fourteen days as part of the aftercare.
Physiotherapy is almost always required for the toes to regain their previous mobility, and this should be started as early as possible. As part of this therapy, the base joints are trained and the long tendons are stimulated. Initially, this can be accompanied by pain.
It is therefore desirable that patients do not initially practice alone, but under the guidance of a trained physiotherapist. Initially, two to three sessions per week are usually required. Once the pain subsides, patients can and should practice on their own.
It is important to regularly monitor the success of the therapy. After about six weeks, you should be able to flex your toes 30 degrees up and about 10 degrees down with your feet straight. Further targets are to be defined for the following weeks.
In order for the operation to be permanently successful, a change in behavior on the part of those affected is usually necessary. In particular, if the hammer toes were triggered or reinforced by the wrong footwear, shoes with high heels or pointed shapes are generally taboo in the period that follows and should only be worn in exceptional cases and then only for a few hours.
You can do that yourself
A hammer toe is not necessarily a medical emergency. If it is detected at an early stage, the foot malposition can be corrected independently through targeted foot exercises and orthopedic measures. A medical examination is therefore absolutely necessary. In consultation with the doctor, the footwear can then be checked and adjusted if necessary.
Possible triggers for claw foot are small or too narrow shoes that are too tight, especially in the toe area. In the case of slight pressure positions, it is sufficient to adjust the shoes individually. One option is to widen the toe cap to give the toes more room. Alternatively, the shoes can be equipped with so-called felt rings. These reduce the pressure on the sensitive toes and prevent pressure points.
In the case of significant misalignments, an orthopedist should be consulted. They can recommend orthopedic insoles and, in severe cases, suggest an operation to correct the misalignment. In any case, a hammer toe should be examined professionally and, depending on the severity, supported or corrected. If the malposition remains untreated, the claw foot will increase over time and cause further complications.