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Overview
Patients and doctors often refer to all forms of toe abnormalities as a Hammer Toe. There are in fact four main forms of toe abnormalities, hammer toes, claw toes, mallet toes and trigger toes. A hammertoe can be best described as an abnormal contraction or "buckling" of a toe. This occurs due to a partial or complete dislocation of one of the joints that form the toe. As the toe continues to be deformed, it will press up against the shoe and may cause corns.

Causes
Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don?t fit well can crowd the toes, putting pressure on the middle toes and causing them to curl downward. Other causes include genes. Some people are born with hammertoe, bunions. These knobby bumps sometimes develop at the side of the big toe. This can make the big toe bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Arthritis in a toe joint can lead to hammertoe.

Symptoms
The symptoms of hammertoe include a curling toe, pain or discomfort in the toes and ball of the foot or the front of the leg, especially when toes are stretched downward. Thickening of the skin above or below the affected toe with the formation of corns or calluses. Difficulty finding shoes that fit well. In its early stages, hammertoe is not obvious. Frequently, hammertoe does not cause any symptoms except for the claw-like toe shape.

Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment
Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.

Surgical Treatment
Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

Prevention
Some different things you can do to help prevent hammer toes from forming and progressing do exist. You can wear supportive shoes to help prevent deformities. Hammer toes are often times related to poor foot mechanics, particularly foot flattening. You can wear custom orthotics prescribed by a podiatrist; orthotics might prevent or slow the progression of hammer toes. You can also avoid shoes with narrow or pointed toe boxes that can compress your toes.