Hammer toe (claw toe)
What is a hammer toe (claw toe)?In many cases, the affected persons are symptom-free, apart from purely cosmetic aspects. In others, the deformity of the toes causes instability, which can lead to pathological stress on the foot
© aytuncoylum - stock.adobe.com
The most painful deformations of individual toes are known as hammer toe or claw toe. One recognizes these misalignments by the curvature of the toe joints.
A hammer toe is when the toe joint is flexed in the extension of the metacarpophalangeal joint. If you suffer from a claw toe, the middle or the end joint is curved, while the toe joint has an overstretching.
Both toe deformities are diagnosed relatively often, with the expression predominates to the hammer toe. It often happens that in addition to the faulty development of the hammer toe or the claw toe, a deformation of the big toe can be observed. This is called "Hallux Valgus".
What are the causes of the pathological development to the hammer toe or claw toe? The main responsibility is the wearing of shoes with too high heels or too tight shoes. The toes do not have enough space. They bump against the toe and can therefore gradually bend.
As the toe muscles are hardly moved these days - especially because the foot is usually trapped in orthopedic unfavorable shoes all day long - it atrophies and the development of the hammer or claw toe is only a matter of time.
But even a malposition of the foot such as the spread, flat or kinked foot can favor the development of the hammer toe and claw toe.
Neurological diseases as well as muscle or nerve injuries of the foot or the lower leg can also be causative. Rarely are genetic factors responsible for the hammer toe or claw toe.
Symptoms, complaints & signs
The hammer toe or claw toe has a characteristic appearance. The main symptom is a typical toe deformity, in which the toe middle link is stretched upward and the toe end member is directed downwards. The shape of the toe thus resembles that of a hammer. The difference between a hammer toe and a claw toe is that in the former, the tip of the toe touches the ground. Many sufferers have more than one toe of the foot affected by a malposition.
In many cases, the affected persons are symptom-free, apart from purely cosmetic aspects. In others, the deformity of the toes causes instability, which can lead to pathological stress on the foot. This is especially the case when several toes of the foot are deformed. This can lead to bruises and severe pain.
In advanced stages, further deformation of the hammer toe or claw toe occurs. The pain increases over time. The affected toe shortens and needs more height. Especially wearing too tight shoes can lead to the formation of corns or painful calluses.
The hammer toe, or the claw toe develops initially relatively inconspicuous: One sees one day a small elevation on a toe or more toes. If one fails to visit the orthopedist in time, the small bony changes gradually produce unsightly humps.
The toe deforms more and more, the middle or end joint bends and bumps against the shoe cover. The result: pressure points on the toe make walking a painful ordeal. It develops corns that can easily inflame by the constant rubbing on the shoe and cause infection.
Diabetics are particularly at risk from the extreme sensitivity of their feet. Failure to timely treatment of the hammer toe (Krallenzehs), it can lead to complete crippling and stiffening.
Through the hammer toe it comes to various complaints and malformations on the toes. The further course of the disease usually depends strongly on the exact symptoms and symptoms. In most cases, however, it comes to a delayed diagnosis of the disease by the patient itself. This is because the complaints are initially inconspicuous and can not be assigned to the hammer toe.
Only later will there be obvious complaints and changes in the bones. The toes are bent and can lead to severe pain. These occur especially when running and can cause restrictions of movement. Not infrequently, it comes to the so-called corns.
Furthermore, the person suffering from the toes can easily develop inflammation and infections. The feet are particularly sensitive to the disease. The treatment of the hammer toe usually depends on its expression. In many cases, no surgery is necessary. There are no further complications. Through various deposits, therapies or implants, the symptoms can be alleviated. Life expectancy is not limited by the hammer toe.
When should you go to the doctor?
A hammer toe does not always cause complaints and usually requires no treatment. However, if pain or further misalignments occur, we recommend a visit to a doctor. When it comes to bruises and corns in connection with a claw toe, orthopedic measures must be taken. Also, infections, bleeding and other complications require a quick clarification and treatment by a specialist. Diabetics are particularly susceptible to a hammer toe.
If the first signs of malposition are noticed, the responsible doctor should be informed. Even with people who suffer from a spread, flat or kink foot, it comes more frequently toe toe. Other risk factors include tight or inappropriate footwear, neurological disorders as well as muscle or nerve injuries.
Those who belong to these risk groups should have the first symptoms directly clarified and in acute symptoms in the next few days visit a doctor's office. Should ulcers or infections develop as a result of the hammer toe, this must be treated immediately, otherwise the symptoms may be severe.
Treatment & Therapy
If the malalignment to the hammer toe or claw toe is not yet pronounced, a conservative so non-surgical treatment is advisable. The orthopedist, for example, prescribes special shoe inserts or night rails that are supposed to stretch the toe overnight.
He prescribes toe gymnastics with the physiotherapist. The wearing of comfortable shoes made of soft leather is also indispensable. The pressure points can also be relieved by special pads. Also, the regular visit to the podiatrist is recommended. Here is the treatment of the corns in the foreground.
The malformation of the hammer toe (Krallenzeh) is usually irreversible by conservative therapy. For severe deformations, only one operation will help. There are several ways to eliminate the curvature of the toes: The surgeon uses an implant such as the SMART TOE®, a newer and more successful method in the affected toe.
Although this stiffens the toe joint, it is stretched and returned to its original shape. Another method is the removal of the affected bone while rebuilding the tendons and muscles. The operation of hammer toe or claw toes is usually performed on an outpatient basis with local anesthesia.
Outlook & Forecast
The prognosis of a hammer toe is based on the expression of the malposition and the age of the patient. If the affected person is still in the growth and development phase, corrections can be made by wearing the footwear or by special exercises of the limbs. If the hammer toe is mild, the prognosis is favorable for the patient. In many cases, a cure can be achieved within a few months if all requirements are successfully implemented.
With the completion of the growth phase, the prospect of a full correction usually worsens. Nevertheless, significant improvements can be achieved with orthopedic measures and individual toe gymnastics.
If there is a severe deformity of the toes, a correction can only lead to a reduction of the existing symptoms through a surgical procedure. If surgery is performed without further complications, quality of life is improved in most cases. Complaints are rarely possible, but not excluded.
The later a medical treatment is initiated and the stronger the malformation is, the less favorable is the prognosis for the patient. In severe cases, a progressive disease is expected or the toe and ankle must be stiffened. This prevents an increase in discomfort along the foot or leg.
So that the hammer toe or claw toe does not even develop, the following preventive measures should be carried out: Above all, comfortable, not too tight shoes with heels not more than three centimeters are important. Also helpful is regular toe gymnastics.
When walking, make sure that your feet roll properly - so the toes are not buckled. Those who consistently pay attention to the health of their feet do not have to worry about suffering under the hammer or claw toe.
The surgical correction of hammer toes affects the joints, tendons and bones. To keep the toe in the desired position, it is fixed with tape bandages or a rail and wires. The tape bandages must be checked regularly and renewed if necessary. Wires are usually removed after fourteen days as part of the aftercare.
For the toes to regain their former mobility, physiotherapy is almost always required and should be started as early as possible. As part of this therapy, the basic joints are trained and the long tendons stimulated. This can initially be painful.
It is therefore desirable that patients initially do not practice alone, but under the guidance of a trained physiotherapist. Initially, two to three sessions per week are usually required. Once the pain subsides, patients can and should practice on their own.
It is important to regularly monitor the success of the therapy. After about six weeks, the toes should be able to be angled 30 degrees up and about 10 degrees down when the foot is stretched. Further goals have to be defined for the following weeks.
In order for the operation to be successful in the long term, a behavioral adjustment by the affected person is usually required. In particular, when the hammer toes have been triggered or reinforced by the wrong footwear, shoes with high heels or tapering shape in the subsequent period are generally taboo and should be worn only exceptionally and then only for a few hours.
You can do that yourself
A hammer toe is not necessarily a medical emergency. If it is detected at an early stage, the foot deformity can be remedied by specific foot exercises and orthopedic measures independently. A medical examination is therefore essential. In consultation with the doctor, the footwear can then be checked and, if necessary, adjusted.
Possible triggers for a claw foot are small or too narrow shoes, which are too tight especially in the area of the toes. For light print positions, it is sufficient to customize the shoes individually. One way is to widen the toe cap to give more room to the toes. Alternatively, the shoes can be equipped with so-called felt rings. These reduce the pressure on the sensitive toes and prevent pressure points.
In case of significant misalignments an orthopedist should be consulted. He may recommend orthopedic insoles and, in severe cases, propose an operation to correct the malalignment. In any case, a hammer toe should be examined technically and be supported or corrected according to its severity. If the malposition remains untreated, the claw foot will still increase during the course and cause further complications.