The term “hammertoe” is a broad term which refers to toes that are no longer straight. The most classic form is when the bend in the toe is primarily in the first joint, or PIPJ, of the toe, causing that joint to raise up prominently, making it vulnerable to painful pressure from the toe box of your shoe. Other times, it is the end joint, or DIPJ, which flexes down, which is called a “mallet toe”. This type of hammertoe generally creates problems with pressure calluses and tenderness at the tip of the toe.
The causes can be multifactorial. Basically, anything which can upset the delicate balance of tendons and muscles which keep the toes on the ground can create hammertoes. Think of a marionette (string puppet), where pulling different strings will cause the puppet to move in different directions. Your toes are very similiar, where the strings are the tendons located in your foot and leg, all working together. If you have overpowering of one tendon or group of tendons, the toes will no longer be balanced and the joints will bend in a hammertoe position.
Having an arch which is excessively high or low can be associated with hammertoes. Also, any foot type which changes the distribution of pressure across the ball of the foot, such as a bunion, can lead to hammering of the smaller toes. This is why your second toe can start to curl up if you have a bunion, even if the bunion is not hurting you.
Certain types of arthritis such as Gout or Rheumatoid Arthritis which damage the joint can destabilize the muscle-tendon balance and lead to hammertoes. For these diseases, treating the underlying arthritis is critical as part of your overall treatment plan, and I often work closely with other medical professionals in these cases.
Nonsurgical therapy generally starts with choosing shoes which allow for more space around the toes. There are also various pads and splints available which can help realign the toe, but these generally are more for comfort and do not provide permanent correction. I carry several of these in my office, and many can be found at specialty shoe stores. Addressing the overall alignment of the foot and supporting the arch with an orthotic can be helpful as well.
When non-surgical measures fail, there are procedures available to surgically straighten toes. A thorough exam and X-ray evaluation is important in pinpointing both the cause as well as the best treatment plan. Sometimes, other causative factors or foot deformities may need to be addressed at the same time to prevent re-occurance.