DEAR DOCTOR K:
Can hammertoe be reversed?
The four smaller toes of your feet are composed of three small bones, connected by two joints. Hammertoe develops when tendons and ligaments — the fibrous tissues that connect muscles and bones to one another — contract. Instead of lying flat, the toes very slowly start to hump up. A bend develops in the joint between the first and second bones; the tip of the toe starts to curl up. The toe resembles a hammer, hence the name.
Hammertoe often develops in the second toe. A bunion often develops first. The bunion causes the big toe to turn inward. The big toe then pushes up on the tip of the second toe, causing it to curl over. (I’ve put an illustration of hammertoe below.)
Hammertoe is more likely to develop in people with arthritis affecting the bones of the foot. Usually, that’s osteoarthritis. Sometimes it’s rheumatoid arthritis. Neurological conditions that deaden the nerves leading to the muscles of the foot and toes also can cause hammertoes. Such conditions include diabetes (which damages small nerves of the feet), strokes, and a variety of other fortunately rare conditions.
Hammertoe can be painful and uncomfortable. If the toes remain bent for long periods, the tendons will tighten because they are not stretched to their full length. Eventually, the tendons shorten enough that the toe stays bent, even when barefoot.
Fortunately, hammertoe can be reversed. Some simple treatments include:
- Splinting the toe to keep it straight and to stretch the tendons of the foot.
- Using over-the-counter pads, cushions or straps to decrease discomfort.
- Exercising the toes to relax the tendons (a physical therapist can recommend appropriate exercises).
- Wearing shoes that fit properly and allow toes plenty of room to stretch out, and generally avoiding ill-fitting, tight or high-heeled shoes.
If the toe has become stiff and permanently bent, the toe can be straightened with surgery. One type of surgery involves removing a small section of the toe bone to allow the toe to lie flat.
Most cases of hammertoe can be prevented by wearing the right shoes. If you go back to tight, pointy shoes, the condition can return even after it has been treated.
If you notice the beginning signs of hammertoe, you may be able to prevent the tendons from tightening. Regularly flatten your toes. Also, soak your feet in warm water every day, then point your toes.
Simple foot exercises also can help to maintain or restore the flexibility of the tendons. For example, place a small towel on the floor and then pick it up using only your toes. Or grasp at carpet with your toes, or curl your toes up and down repeatedly.
Fortunately, hammertoes take a long time to develop. If you notice them starting, you can often prevent them from worsening by following the advice I’ve given.