Bent Toe Disorders (Hammer, Mallet and Claw)

A bent toe disorder is an oddly bent toe joint. Hammer, mallet and claw toes are often painful and commonly occur in one or more of the four smaller toes. These three deformities can be identified by unique characteristics:

• Hammertoe: The middle joint of the toe bends down, causing the front of the toe to rise up. It usually affects the second toe and it often occurs alongside bunions.
• Mallet toe: Unlike the hammertoe, the joint closest to the tip of the toe bends down. It often affects the second toe.
• Claw toe: The joint connecting the foot and toe bends up, while the remaining joints leading to the tip of the toe bend down. Claw toes often occur in the four smaller toes at the same time.

Causes

The most common cause of these toe problems are tight shoes, which may unbalance the toe muscles. When your toes are forced to stay in a bent position for too long, your muscles tighten and your tendons may shorten or contract. This makes it harder for your toes to straighten out, even when not wearing shoes.
It should be noted that these toe problems doesn’t appear overnight. They form over the years. Although common among adults, women are more prone to toe deformities such as hammer, claw and mallet toes because they are more likely to wear shoes with narrow toes or high heels.
Other causes linked to these toe problems are conditions such as diabetes, rheumatoid arthritis and foot injuries.

Symptoms

Besides looking odd, hammer, claw and mallet toes may:

• Hurt
• Make it hard to find shoes that fit
• Rub against your footwear or other toes, causing calluses or corns.

Potential Treatments

To diagnose a hammer, claw and mallet toe, your doctor will ask questions about your symptoms, check your medical hirstoy, and do a physical exam.
Your doctor may want to know the following:

• When the problem started, what activities or shoes make them worse, and if other parts of the foot are painful.
• What kind of shoes you wear and how much time you spend standing or walking everyday.
• Any previous foot problems you have had.
• Any medical conditions you have that could be related, such as arthritis, diabetes or poor circulation.

During the physical exam, your doctor will look at your foot to see if the toe joint is fixed or flexible. A joint that has some movement can sometimes be straightened without surgery, while a fixed joint often requires surgery.

Drugs that reduce inflammation can ease pain and swelling. Sometimes, a doctor will use cortisone injections to relieve acute pain.
An orthotics specialist or qualified medical provider such as a podiatrist may also make a custom insert to wear inside your shoe. This can reduce pain and keep the hammertoe from getting worse.
Over-the-counter metatarsal pads that are properly placed may help as well.
The doctor may recommend foot exercises to help restore muscle balance. Splinting the toe may help in the very early stages to avoid surgery.

However, if your doctor recommends surgery to correct your toe problem, you may need the following tests:
X-rays. Your doctor may order X-rays to see if surgery is required.
Blood flow tests. If your foot seems to have poor circulation, your doctor may test your blood flow, which could include a doppler ultrasound.
Nerve tests. If your doctor thinks you have nerve problems in your foot, a nerve testing can be done. In this case, you may need to see a neurologist too – a doctor specializing in brain, spine and nerve problems.

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