Hammer toe is a condition where the middle joint of a toe bends upward. The bend causes the tip of your toe to turn downward so that it looks like a hammer. Ulcerations can occur on the top of the bent middle joint because of friction and pressure from the shoe.
If you’re experiencing hammer toe on your second, third, or fourth toe or even multiple toes at once, there are several types of hammer toe splints designed to relieve or prevent the related foot issues.
Difference between splint and orthotic
The U.S. Centers for Medicare and Medicaid Services (CMS) now defines an orthotic device, or orthosis, as an artificial support for a part of the body. An orthotic may be prefabricated or custom made to fit you.
CMS defines a splint as a cast or wrapping material used to help set a broken, fractured, or dislocated bone.
This new terminology is gradually replacing the old usage, where the terms splint and orthotic sometimes overlapped. What used to be called a hammer toe splint is now called an orthotic.
What a hammer toe orthotic does and doesn’t do
- Provides passive force or pressure. The point of a hammer toe orthotic is to exert a straightening force on the muscles that bend your toe. This helps to keep the muscles from tightening in the curled position that can make the condition worse.
- Doesn’t fix broken bones. A hammer toe orthotic doesn’t straighten the bone the way a splint that’s applied to a broken bone does. This is because the bone itself isn’t broken when you have hammer toe. Rather, the muscles that bend the joint have contracted, causing the bend in your toe.
- Is preventative. Much of the pain of a hammer toe comes from the bunion or formation it usually produces on the top of your affected toe. Hammer toe orthotics don’t make the bunion go away, but they may control the pain. They may also prevent the bend in the toe from worsening.
You may have success trying out different over-the-counter orthotics until you find one that helps. Some people need a combination of orthotics, such as a heel pad along with a hammer toe orthotic.
You may find that a foot specialist can get you to a solution faster, and even more cheaply. You’re likely to have happier feet if you find a good specialist to work with. Overall this may solve hammer toe problems efficiently and effectively.
There are a variety of over-the-counter hammer toe orthotics available. With all of these devices, it’s important that you wear well-fitting shoes with lots of room in the toe box. If you try to squeeze an orthotic into tight-fitting shoes, you could make things worse.
Some of the orthotic types include:
This is a thin elastic bandage with Velcro strap that can bind the hammer toe to the one next to it. These are very effective for some people. They’re minimally invasive and can be washed and reused. You may have problem keeping them on if your toes are short or curve to the side.
Toe socks, or toe separator socks more specifically, are socks with five toe hole cutouts and padding that helps separate your toes. These take up little space and are unlikely to cause irritation, though they will not provide as much separation as other types.
Over time, they may provide gentle relief. If you have trouble finding a good fit, you could make your own separator sock by cutting holes in a well-fitting, thin sock.
Gel toe separators (also called spreaders, relaxers, or stretchers)
These are like cut-off gloves made of gel that separate the toes and help keep them straight. Some types are made to separate all five toes and some just two. Gel toe separators can be effective if they fit properly, especially if you have crossed toes. Otherwise they’re awkward and can be irritating.
Be aware of size, especially in the type meant for all five toes. Toes vary greatly in length, circumference, and spacing. A one-size separator does not fit all.
If you use a toe separator that’s too large for you, it can cause pain when stretching your toes apart or rubbing your toes inside your shoe. Try on different types until you find one that fits your toes.
Ball of foot (metatarsal/sulcus) cushions
The metatarsals are the five large bones of your feet that attach to your toes. Some of the pain of hammer toe is transferred to the metatarsals. Insoles that cushion the ball of your foot or provide extra support just beneath the toes can sometimes provide relief.
Hammer toe crest pad
A toe crest pad is a ring of material that goes around the hammer toe and is held in place by an attached pad that sits under your toes. They are usually made of gel or felt. If not too irritating, they can be helpful to some people with overlapping toes.
Having enough room in your shoes for your toes to splay out in a natural way will have a big effect on correcting or worsening hammer toes. New shoes might be something you can’t get right now. Until you’re able to, try to wear the right orthotics at home when you can be barefoot or as you sleep.
When you do look into new shoes, wear your orthotics while you try shoes on to find the right size and fit.
Understanding the anatomy of the toe can help you in selecting the right over-the-counter orthotic or in understanding a doctor or orthotist’s recommendations. Here are fast facts on your toe joints:
Your toe is made up of three small bones, known as phalanges. Starting from the tip of your toe, the three bones are:
- the distal (end or tip)
- the middle
- the proximal (closest to your foot)
The joint that’s affected in hammer toe is the proximal interphalangeal joint (PIPJ). This is the middle joint between the proximal phalanx and the middle phalanx. The PIPJ is bent downward (flexed).
The metatarsophalangeal joint (MTPJ) is in either the neutral position and hyperextended position. The distal interphalangeal joint (DIPJ) is either hyperextended or in the neutral position.
If over-the-counter orthotics don’t work for you or make things worse, it’s a good idea to talk to a doctor.
Foot specialists (podiatrists) can prescribe a custom-made orthotic that will work best for you. A professional known as an orthotist or prosthetist can design an orthotic to fit your foot and precise condition.
There are also many things your foot doctor can look for that you may not be aware of. These include:
- excessive pronation
- flexible deformities
- mixed conditions, such as hammer toe combined with Achilles tendinosis
If pain continues or increases despite orthotics, surgery is sometimes the only solution. A procedure known as resection arthroplasty is the one most commonly used.
In resection arthroplasty:
- A surgeon removes part of one of the toe bones.
- The tendons are cut and reattached.
- A wire or tape is used to hold the toe straight until it heals up, usually in three to six weeks.
Healthy people can usually have the procedure done without an overnight stay in the hospital.
A study in 2000 of 63 people (118 toes) found that resection arthroplasty relieved pain for 92 percent of the people studied. Five percent experienced minor complications. The study was done an average of 61 months after completion of surgery.
The main cause of hammer toe is frequent wearing of shoes that are too tight in the toe box, including high-heeled shoes. The condition often occurs gradually, although it can be brought on by trauma.
Hammer toe can also be a secondary result of another toe deformity known as hallux valgus. Hallux valgus is a misalignment of the big toe that usually causes a bunion on the outside of the toe.
The misalignment of the big toe causes crowding of the smaller toes. The crowding can lead to a hammer toe, just as if the bones were being pressed by high heels or a tight toe box.
Two related conditions are mallet toe and claw toe. Mallet toe happens when the distal interphalangeal joint, not the middle joint, bends downward.
In claw toe, the metatarsophalangeal joint is in hyperextension and the proximal and distal interphalangeal joints are in flexion. These related conditions also occur on the second, third, or fourth toes, and can cause a painful bunion to form.
Hammer toe and its accompanying bunion can be painful and disruptive to your life. A variety of over-the-counter orthotics and aids may be able to help relieve your pain. If these don’t work for you, doctors can prescribe custom-fitted orthotics that may do the trick. As a last resort, surgery can be effective.
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