There are 5 phalanges, commonly referred to as toes, that connect with the long metatarsal bones that make up the forefoot. The toes are made up of 3 joints: distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, and metatarsophalangeal (MTP) joint.
What are Hammer Toes?
Hammertoes are created when the PIP joint is flexed, the DIP joint is extended, and the MTP joint is either neutral or extended. The toe deformity points upward and then the end of the toe downward, appearing like a hammer. Early deformities are typically less rigid whereas progressive hammertoes are rigid from tightness of the tendons and require surgical correction.
Primary Causes that Lead to a Hammer Toe
- Bunion deformity, causing second hammer toe.
- Excessive tightness of extensor digitorum longus.
- Long second toe.
Secondary Causes that can Lead to Hammertoe
- Rheumatoid arthritis.
- Diabetics with peripheral neuropathy.
- Inflammatory joint disease.
- Connective tissue disorders.
- Unequal muscle firing patterns of foot intrinsic musculature.
- Abnormal gait mechanics caused by sprain, strain, or fracture.
- Forefoot and midfoot instability.
- Poorly fitted shoes (most common cause – narrow shoe box, high heeled shoes).
Doing conservative care can have many benefits in managing a hammertoe deformity; however, this will not change the structure of the toe. There are ways to prevent a hammertoe from becoming more disabling such as use of orthotics, shoe wear (Alta’s, Hoka’s, etc) with a wider toe box, padding calluses or corns, and splinting. There is also benefit to improving the strength in the foot to improve the efficiency with weight transfer and walking.
Despite the fact that Physical Therapy can minimize or reduce the effects that the presence of a hammer toe can create, and can help reduce or eliminate pain associated with the presence of a hemmer toe, the only way to correct the structural deformity itself is surgery. This does not mean that every person that has a hammer toe will have pain, or will be limited in their ability to be active. The goal should be to restore quality of life, and Physical Therapy is an indicated way to do so.