Hammer toes are considered a static deformity of the forefoot. This is a defect most often caused by two factors: mechanical irritation in the shoe and muscle imbalance between groups of muscles, namely toe flexors and extensors. Typically, the condition involves a combination of both.
Mechanical irritation is due to the repeated and long-term wearing of inappropriate shoes. That is one reason why the deformity seldom appears in people before they turn 50, 60 or 70. The worst types of shoes are those with high heels and a narrow toe, which leads to higher risk of hammer toes in women.
Muscle imbalance occurs between the muscles that move our toes up and down. These two muscle groups would ideally be absolutely balanced to prevent any overloading or shortening of one at the expense of the other. It is this mechanism that leads to toe deformities, not just hammer toes but also club toes or claw toes. All of these defects are very similar, the toes are just bent and deformed in different joints.
In the case of hammer toes, the toe becomes bent upwards at the joint between the metatarsal bone and the first phalanx and downwards between the first and second phalanges. The toe thus becomes scrunched. Gradually, as the muscles become increasingly shortened, the toe can no longer be straightened. At the same time, there is greater friction of the head of the first joint against the shoe, resulting in sores, calluses and corns which can extend as far as the nerve. Pressure sores can also form under the ball of the toe or under the transverse arch, resulting in pain when walking and, subsequently, more changes in gait that may be transmitted to our entire body.
Hammer toes are very often associated with fallen transverse arches as well as bunions. This stands to reason as all of these problems share the same root cause, high heel shoes with narrow toes which direct all of the body’s weight onto the tips of the toes.
This means that even conservative treatment of these conditions should be the same, focused primarily on changing footwear to shoes without high heels that are sufficiently wide in the toe with around 1 to 1.5 cm of toe room. Another essential component of conservative treatment is physiotherapy, which should focus on correcting gait, stepping and pushing off properly, stretching shortened muscles, relaxing the small joints of the foot and toes, and overall contributing to leg function without muscle imbalances. This form of treatment can be supported with aids such as silicon correctors, a metatarsal pad under the transverse arch, etc. Another very effective aid for hammer toe exercises is kinesio tape, which helps to correct the functional position of the forefoot, especially the transverse arch. Likewise, it is good to support therapy by wearing Foot Alignment socks, which help both mechanically and by improving circulation and relaxation. Good circulation helps eliminate substances created in overworked muscles and also the subcutaneous tissue, skin and other soft tissues, thus helping to heal corns and calluses. Callus care should always be a part of hammer toe treatment.
If conservative treatment fails to yield results or was started too late and the deformity does not improve and the pain does not lessen, then one may opt for surgery. Surgery is generally performed as an outpatient procedure under local anesthesia, so it is less demanding than surgery for other foot problems. Even so, prevention is always better than such a radical solution. Every operation carries with it risks of varying severity, which is why even after surgery, follow-up treatment in the form of active physiotherapy is important.
How we treat our feet is very important: how much room we have in our shoes (or not), how we care for our feet and how we allow them to relax. Foot Alignment socks are an excellent start on the road to healthy feet.