HAMMER, MALLET OR CLAW, OH MY!
Hammer toes, Mallet toes and Claw toes are three types of digital deformities of the foot that are extremely similar, yet vary from one another depending on the joint within the toe that is most affected. The term “hammer toe” is often used to encompass all three deformities, but they are distinct entities. To make the distinction relatively simple, remember that each of your toes, numbers 2 through 4 have three joints. In a hammer the middle of those three joints is the cause of the deformity, where as in claw toes it is both the middle and end joints and for mallet toes it’s only the end joint.
Digital deformities of this type are typically a result of muscular imbalance within the foot. What does that mean? Each of us is made with a different foot type and although some of us are perfect, or have perfect feet, we only make up about 20% of the population. That means that the other 80% of the population have a foot type that predisposes them to some type of deformity during their life; whether that be hammer toes, bunions, flatfeet etc. If you think about those statistics, abnormal is normal and normal is abnormal when talking about our feet! Either way, your body and more importantly your toes attempt to compensate for the muscular imbalances within the foot to increase foot function, and as a result they hammer, or contract at one or several of the joints within the toe.
Some less common causes of hammer, mallet or claw toes include joint diseases, such as rheumatoid arthritis, spinal cord or nerve injuries which weaken the muscles within the foot, decreased blood flow and decreased feeling in the toes, and a history of trauma to the toe such as fracture.
Prevention of digital deformity is much the same as preventative methods for development of bunions (hallux abducto valgus), which we discussed over the last two weeks. The etiology of the deformity must be identified early and corrected so that the foot never needs to compensate for that abnormality. Certainly wearing comfortable and supportive shoes, contrary to shoving toes into “pointy-toed” stilettos will decrease your chances of developing hammertoes, but it is a deformity that is much less predictable for occurrence than some other more debilitating and noticeable deformities of the foot.
The primary patient concern with this type of deformity includes corns that develop on the top of the affected digit and increased pain while wearing shoes due to increased pressure over the toe. It is likely and prudent that your doctor will suggest conservative treatments prior to any surgical interventions, although both are viable options. To decrease such symptoms conservatively and make the deformity more manageable, your Podiatrist can trim the corns down. By taking down the dead skin, the pressures over the toe will become less and pain will also decrease. Your Podiatrist will also recommend padding of the toe to eliminate pressure created between your toe and the shoe. They may use a strapping device that will “buddy” the toe to a more stable digit, bringing it down into line with the other digits. Of course, wearing shoes with a wider and roomier toe box will alleviate pressures and decrease pain as well. Injection therapy is not a conservative treatment that is offered due to the size of the digit and the minimal degree of relief that it may provide.
If patients can tolerate padding in their shoes and occasional trimming of their corns, conservative care of the deformity can provide a long-term result. It is likely that decreasing such pressures will decrease symptoms and hammer toes can become quite manageable conservatively! If all conservative treatments fail and you are ready to consent for a surgical approach to fixing your hammer, mallet or claw toe, your Podiatrist can certainly recommend something that will reduce pain and pressures. Next week we will discuss the surgical options for treating your deformity including what to expect after surgical correction.