Under the Microscope: Hammertoe

What is it?

Hammertoe is characterized by a bend in the joint of any toe except the big toe. The bend in the joint causes the top of the toe to appear to curl under as if it’s “hammering” into the floor. The most common toe to suffer is the second one. While the smallest toe can be affected, the condition causes that toe to twist out to the side rather than to curl forward. Hammertoe is not very discriminating; it may appear on all four toes of the foot or on only one toe, depending on the cause. Often a person with a bunion will have a hammertoe on the second toe, because the bunion has pushed the big toe in and crowded the second toe. Corns may develop on the skin covering the joints after the bent toe repeatedly rubs against the tops of shoes, and the area may become red and swollen.

How do you get it?

Hammertoe is an imbalance in the tendons and muscles. Over time, the imbalance in those tendons and muscles begins to cause the joint to bend. Many people are genetically predisposed to hammertoe, and the condition begins to progress more quickly when they wear shoes that fit poorly. Hammertoe may also be caused by damage to the joint as a result of trauma.

How is it treated?

Hammertoe is a progressive disease, which means it will keep getting worse unless it’s treated. For mild cases of hammertoe, where the tendons and muscles are bending the joint but the joint isn’t rigid, doctors choose from a variety of treatments. If the toes are still mobile enough that they are able to stretch out and lay flat, the doctor will likely suggest a change of footwear. The doctor may prescribe pads to ease the pain of any corns and calluses, and medications ranging from ibuprofen to steroid injections for the inflammation and pain. Other options for non-surgical treatments include orthotic devices to help with the tendon and muscle imbalance or splinting to help realign the toe. If these non-invasive treatments don’t work, or if the joint is rigid, a doctor’s only recourse may be to perform surgery. During the surgery, the doctor makes an incision and cuts the tendon to release it or moves the tendon away from or around the joint.

What can a tech do?

If a nail technician suspects a client has hammertoe, she should recommend the condition be evaluated by a foot and ankle surgeon. Early diagnosis always produces better results so alternative treatments can be attempted before the joint becomes rigid. Techs may perform a pedicure as they normally would if the skin is not compromised in any way. However, if any sores have developed on the skin, the tech should recommend the client visit a doctor before performing services, especially with clients who have diabetes.

What else?

Hammertoe sufferers should resist the urge to self-diagnose. Pads for the toes and corn cushions are available over the counter, so clients may be tempted to try them on their own before they visit a podiatrist. However, some types of hammertoe respond better to a specific pad, and the doctor would know which one a client would need, if any. Sufferers should avoid using medicated corn cushions, because they may contain acid, which could be harmful.