Hammertoes and other related toe contractures (claw toe, mallet toe) are common conditions caused by abnormal forces acting on the muscles that control the position of the toes. Seen in patients with both flat feet and high arches, the stress placed on the leg muscles by the abnormal arch position causes a change in the position of the toes over time. Like bunions, these are usually inherited, and represent an imbalance between muscles that pull the toes up and muscles that pull the toes down. With these contractures, areas on the toe can become very prominent against the top of the shoe. This can cause painful corns to form at the area of prominence. Corns can also occur at the side of the toe as sometimes the toe rotates to one side (especially the little toe), and the bones of each adjacent toe press on the skin in between them. Additionally, the contracted toes can push down and cause stress to the ball of the foot. Arthritis can develop in the toe joints, and some toes can cross over or under an adjacent toe as ligaments stretch and tear.
Treatment can include padding to protect the toe from the shoe or other toes, as well as regular trimming of the corns. Pads are available from a variety of sources, and often contain gel to displace the pressure. Trimming of the corns should be done only by a professional, and if one is diabetic or has nerve disease or poor circulation this should only be performed by a doctor. As an alternate, one may file the corns lightly with an emery board or pumice stone after bathing. Deeper shoes can also help, as this decreases the pressure to the top of the toes. Orthotics (prescription shoe inserts) in some instances may control the progression of the toe contractures. Permanent correction can only be achieved through corrective surgery to straighten the toes and remove any prominent bone. Usually the prominent bone is partially removed or shaved, and the soft tissue around the to is realigned to make it straighter. Sometimes the toe joint is fused in severe cases. A wire is usually used to stabilize the toe as it heals in a straight position, which is then easily and generally painlessly removed in the office. This procedure takes very little time, has a very low complication rate, and most patients are back into regular shoes within a month. Some mild swelling of the toes can be expected lasting several months after surgery, however this almost always resolves on its own or with a little help from a compressive wrap.
One final note is offered on patients who have no pain or limitation but are considering cosmetic surgery to make their toes look "prettier". Most surgeons will strongly advise against this for a number of different reasons. The first and foremost is that surgery on the feet is almost universally formed to decrease pain and increase function of the foot. When there is no pain, no functional decrease, and the condition is not likely to cause a significant problem in the future if left untreated, then there is no need for surgery. Secondly, while toe surgery often leaves a very cosmetically appealing result, the expectations of someone simply seeking cosmetic change are often much higher than what is realistic for that particular procedure. Thirdly, any type of foot surgery is not without inherent risk. The benefit gained by "prettier" toes hardly ever outweighs the risk of an operation, even with the low risk of complications seen with toe corrective surgery. Please consider this when making decisions about having surgery performed in absence of pain or limitation.