Hammer finger How complications arise and how to treat the problem quickly

Hammer toe is a common condition that affects the shape and movement of the fingers or toes, causing pain and difficulty in daily activities. If not properly treated, it can worsen and make daily tasks more challenging or lead to complications. In this article from Dely Medical, we’ll explore the causes of hammer toe, its symptoms, diagnostic methods, treatment options including medication and surgery, as well as exercises that can help speed up recovery. Additionally, we will provide important prevention tips to avoid worsening the condition, helping you maintain healthy fingers or toes and prevent pain and complications.

What is Hammer Toe?

Hammer toe is an injury that occurs when a toe or finger extends beyond its normal range of motion, often caused by sports like football or baseball, especially when trying to catch a ball that hits the tip of your finger. The finger or toe that you use the most is the most vulnerable to this injury.

How Does Damage Happen?

The injury affects the tendons and pulleys in the hand or foot that help bend the fingers or toes. These tendons connect the muscles of the forearm or leg to the bones of the fingers or toes, allowing them to move smoothly. When hammer toe occurs:

The pulley at the base of the toe thickens, making tendon movement difficult.
The tendon may tear or detach from the bone.
Sometimes, the bone itself may be damaged.
Swelling or inflammation may appear.

Early Signs of Hammer Toe

If you notice any of the following:

Pain in the toe
Swelling
Difficulty fully straightening the toe

Tips for Managing Hammer Toe

Use a splint to keep the toe straight.
Avoid using the affected hand or foot for heavy activities.
Follow up with a doctor for injury assessment and recovery guidance.

Risks of Not Treating Hammer Toe

If left untreated, hammer toe can cause:

Permanent deformity
Limited movement in the affected finger or toe

Steps for Managing Hammer Toe

Wear a splint for at least 6 weeks.
Follow up with your doctor for appropriate treatment.

Can the Injury Return?

Yes, hammer toe can return if the injury is not treated properly or if there is another impact to the toe after healing.

Frequently Asked Questions About Hammer Toe

Does hammer toe affect all toes?
- It usually affects the second or third toe, but it can also occur in fingers.
Does hammer toe get worse over time?
- Yes, if untreated or if prevention measures are not taken, the bending can become permanent, making it difficult to move the toe.
Is hammer toe always painful?
- No, some people may have hammer toe without pain, but it can become painful when wearing tight shoes or engaging in certain activities.
Are children at risk of hammer toe?
- It is rare, but it can occur if there is a congenital defect or a direct injury to the foot or hand.
Can you play sports with hammer toe?
- Yes, but it’s best to wear comfortable shoes or use a brace to reduce pressure on the toe.
Is hammer toe inherited?
- In some cases, yes, especially if there is a family history of deformities in the toes or fingers.

Types of Hammer Toe

Flexible Hammer Toe
- The bending is temporary and the toe can be manually straightened.
- This type occurs in the early stages of the injury.
- Treatment is often non-surgical: exercises, wide shoes, or a toe splint.
Rigid Hammer Toe
- The bending is permanent and cannot be straightened manually.
- Usually caused by joint stiffness or tendon scarring.
- Often requires surgery to correct the deformity.
Congenital Hammer Toe
- Present at birth due to abnormal development of the tendons or bones.
- It can occur in children or adolescents.
- Treatment depends on the severity of the deformity, with exercises or surgery.
Acquired Hammer Toe
- Develops as a result of an injury, muscle or nerve imbalance, or wearing tight shoes for prolonged periods.
- More common in adults and elderly individuals.
Hammer Toe Linked to Other Conditions
- Certain chronic health conditions such as:
  - Diabetes
  - Rheumatoid arthritis
  - Nerve or muscle disorders

Stages of Hammer Toe

Flexible Stage
- Description: The bending appears intermittently and the toe can return to its normal position manually.
- Symptoms: Mild pain when pressure is applied or when wearing tight shoes, slight swelling.
- Treatment: Corrective exercises, wide shoes, toe splint, avoid tight shoes.
Semi-Rigid Stage
- Description: The bending becomes more pronounced, but the toe can still be partially straightened manually.
- Symptoms: Moderate pain, difficulty wearing some shoes, small indentations in the middle toe joint.
- Treatment: Exercises and tendon stretches, splints, and sometimes minor surgery if it does not improve.
Rigid Stage
- Description: The bending is permanent and cannot be manually straightened.
- Symptoms: Severe pain, permanent swelling, difficulty walking or wearing shoes, the formation of corns or thickened skin on top of the toe.
- Treatment: Surgery is often needed to repair or modify the tendons and bones.
Chronic Complications
- Description: Occurs when the condition is left untreated for a long period.
- Symptoms: Repeated skin infections, corns, sores, loss of natural movement in the toe.
- Treatment: Extensive surgery, removal of corns, treatment of infections, and sometimes realignment or fusion of the toe.

What Causes Hammer Toe?

Wearing Improper Shoes
- Tight or short shoes force the toes to bend forward. Over time, muscles and tendons shorten, locking the toe in a bent position.
- High heels increase pressure on the front toes, especially the big or second toe, leading to long-term changes in toe shape.
Muscle Imbalance in the Foot
- Each toe is moved by extensor and flexor muscles and tendons. Weakness in some muscles or tightness in opposing muscles causes the toe to permanently bend at the middle joint, forming a hammer toe.
Injuries or Trauma
- Foot or toe fractures: Even if healed normally, the toe may remain in a bent position.
- Sprains or repeated impacts can stretch or tear tendons, leading to the formation of the bent toe.
Chronic Health Conditions
- Diabetes: Can cause nerve damage and muscle weakness, making it difficult to keep the toe straight.
- Rheumatoid Arthritis: Chronic inflammation can lead to stiffness and deformity in joints, including the toes.
- Other Neurological Diseases: For example, Charcot-Marie-Tooth disease, which weakens small foot muscles.
Genetics and Structural Factors
- Some people naturally have longer toes, shorter ligaments, or a tendency for the toes to bend, making them more susceptible to hammer toe under pressure or repetitive motion.
Repetitive Pressure or Overuse
- Sports activities, standing for long periods, running, or putting weight on the toes can stress the small joints and cause tendon tightening, locking the toe in a bent position.
Weak Muscles or Tendons
- As we age or due to previous fractures or disuse of the foot, small muscles weaken. The weakened muscles cannot support the toe properly, causing a gradual bend.

Symptoms of Hammer Toe

Bent Toe
- The main sign: The toe cannot remain straight and curls at the middle joint.
- Initially, the bending may only occur when wearing tight shoes, but over time it becomes permanent, even without pressure.
Pain or Tenderness
- Pain is usually felt at the top of the foot or at the bent joint.
- It worsens when wearing tight shoes or walking for extended periods.
- It may be mild but can worsen with activity or friction.
Redness or Swelling
- May appear at the bent joint or at the base of the toe.
- Swelling and redness may also lead to sores if shoes press against the toe.
Corn or Callus Formation
- Continuous rubbing against shoes causes corns or blisters on the top or tip of the toe.
- These can become very painful, especially when walking.
Difficulty Wearing Shoes
- As the condition progresses, it may become difficult to wear regular shoes due to the toe’s bent position.
Stiffness or Limited Movement
- In advanced stages, the toe may remain locked in a bent position and can no longer straighten completely.
- This affects balance and walking.
Impact on Neighboring Toes
- Pressure on neighboring toes can cause pain or minor deformities in those toes as well.

Diagnosing Hammer Toe

Clinical Examination
- The doctor will examine the toe, observing:
  - The shape of the bend in the middle joint
  - The ability to manually straighten the toe
  - Swelling or inflammation around the joint
  - The presence of corns or thickened skin on the top of the toe
Medical History
- The doctor will inquire about:
  - When the toe started bending and the first symptoms
  - Any previous injuries to the toe or foot
  - Activities that may be contributing to the condition (sports, manual labor, tight shoes)
  - Chronic conditions that affect tendons or joints (like diabetes or rheumatoid arthritis)
Imaging Tests
- X-ray: Used to identify any old fractures or bone deformities, assess the degree of bending, and examine changes in the joint.
- Ultrasound or MRI: These tests help evaluate the tendons for partial tears or inflammation and are useful for planning surgery.

4. Functional Tests (Movement and Strength Assessments)

Assessing the ability to open and close the toes/fingers
Evaluating the strength of the extensor and flexor muscles of the affected digit
Determining the impact of the condition on daily activities like typing, carrying objects, or wearing shoes

Hammer Toe Complications

Persistent Pain
- Pain in the toe joint, especially when walking or standing for extended periods.
- Pain increases with tight shoes or high heels.
Skin Infections
- Continuous friction between the toe and shoe causes itching, redness, blisters, or cracks.
- Sometimes, boils or sores may form if the pressure on the toe is severe.
Formation of Corns/Calluses
- Continuous pressure on the upper or front part of the toe causes skin hardening or the formation of painful corns.
Difficulty Moving the Toe
- Hammer toe causes the toe to remain bent, reducing its ability to straighten fully or move naturally.
- In severe cases, it becomes difficult to wear regular shoes.
Worsening Deformity Over Time
- Without treatment, the bending increases gradually.
- It may affect neighboring toes and increase pressure on them, causing new foot issues.
Balance and Walking Problems
- Pain and deformity change the natural walking pattern, adding strain to the ankle, knee, or back.

Preventing Hammer Toe and Preventing Its Progression

Avoid Tight or High-Heeled Shoes
- Tight shoes put pressure on the toes and increase the chance of bending the middle joint.
- Comfortable shoes with enough space for the toes reduce pressure and protect tendons.
Strengthen and Stretch the Toes
- Perform gentle toe extension and flexion exercises daily.
- Toe lifting exercises or using a small ball for physical therapy strengthen the tendons and reduce contractions.
Use Toe Protectors or Splints as Needed
- Use a toe splint or a rubber protector while walking or exercising to keep the toe straight and prevent further bending.
Control Chronic Conditions
- Diabetes and rheumatoid arthritis can weaken tendons and joints.
- Managing blood sugar, blood pressure, and medications reduces the risk of hammer toe progression.
Avoid Repetitive Strain or Sudden Movements
- Reduce activities that put pressure on the toes for long periods, such as lifting heavy weights or running in tight shoes.
- Take breaks if your job or sports activity puts strain on your toes.
Maintain an Optimal Weight
- Excess weight increases pressure on the feet and toes, thus raising the chance of injury or worsening the deformity.
Regular Check-ups with a Specialist
- Early detection of any slight toe bending helps prevent the condition from progressing.
- The doctor may recommend custom splints or exercises to prevent worsening of the deformity.

What to Look for in Shoes to Prevent Hammer Toe

Adequate Toe Space
- Shoes should not be tight in the front.
- The toes should have space to move freely without pressure or bending.
- Ideally, there should be 1-1.5 cm between the longest toe and the front of the shoe.
Low and Stable Heels
- High heels put pressure on the toes and increase the risk of hammer toe.
- Comfortable heels of 2–3 cm or lower reduce pressure and maintain the natural alignment of the toes.
Good Arch Support
- Shoes should provide support to the arch and heel to distribute weight evenly.
- This reduces pressure on the toes and small joints.
Flexible and Comfortable Sole
- The upper part of the shoe should be made of flexible material (leather or fabric) to allow toe expansion.
- The insole should be cushioned and lightweight to absorb impact while walking.
Secure Closure
- Shoes with laces or Velcro are better than slip-ons.
- They secure the foot without applying pressure on the toes.
Avoid Too Pointed Shoes
- Pointed toes put pressure on the front toes, increasing the likelihood of worsening the bend.

Hammer Toe Treatment with Medications

Medications for hammer toe are typically used to reduce pain and inflammation, especially in the early stages before severe deformity develops. Details are as follows:

Pain Relievers
- Purpose: Relieve pain caused by friction or inflammation in the toe joint.
- Examples:
  - Paracetamol (for mild to moderate pain).
  - Stronger pain relievers prescribed by a doctor for severe pain.
- Tips: Adhere to prescribed doses to avoid liver or stomach problems.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Purpose: Reduce inflammation, swelling, and pain.
- Examples: Ibuprofen, Naproxen, Diclofenac.
- Usage:
  - Oral tablets or capsules.
  - Topical creams or gels to reduce pain directly on the affected toe.
- Important Tips:
  - Take with food to reduce stomach irritation.
  - Avoid long-term use without doctor supervision to prevent kidney or stomach issues.
Corticosteroid Injections
- Purpose: Reduce severe or chronic inflammation around the toe joint.
- When Used:
  - If pain relievers and NSAIDs do not work.
  - In cases of persistent pain or swelling in the joint.
- Tips:
  - Must be administered under medical supervision.
  - Overuse of injections may weaken the tendon or increase the risk of worsening the deformity.
Dietary Supplements
- Purpose: Support tendon and muscle health associated with the affected digit.
- Examples:
  - Collagen peptides.
  - Vitamin C and D to strengthen tissues.
  - Omega-3 fatty acids to reduce inflammation.
- Notes: Often used in conjunction with physical therapy for best results.

Surgical Treatment for Hammer Toe

Surgery is usually reserved for advanced or chronic cases that do not respond to medication or physical therapy, or if the deformity causes difficulty with movement or persistent pain. Common types of surgery include:

Joint Fusion (Arthrodesis)
- Description: Fusing the hammer toe joint partially or fully to stop the movement causing pain.
- When Used:
  - Chronic cases with severe pain.
  - Advanced joint injury or permanent deformity.
- Benefit: Stops the toe from moving, reducing pain, and restoring the ability to grip objects.
Bone Removal (Excision Arthroplasty)
- Description: Removing part of the bone in the joint to reduce friction and tendon adhesions.
- When Used:
  - Toe deformity with severe friction or joint stiffness.
- Benefit: Reduces pain and partially improves toe movement.
Tendon Repair/Transfer
- Description: Reattaching or adjusting the tendons of the toe to correct its position.
- When Used:
  - Tendon rupture or weakness due to chronic inflammation.
  - Deformities that can be fixed without losing full movement.
- Benefit: Restores normal movement and strength and corrects the position of the toe.
Adhesion Release/Scar Tissue Removal
- Description: Removing adhesions that limit the flexibility of the toe following injury or surgery.
- When Used:
  - Stiff toe or loss of movement after prolonged injury or inflammation.
- Benefit: Improves movement range and prevents further deformity.
Minimally Invasive Surgery (Arthroscopic Surgery)
- Description: Using a camera and precision instruments to repair or release the tendon without fully opening the wound.
- When Used:
  - Cases near the joint requiring high precision.
- Benefit: Faster recovery, less pain post-surgery, and small scars.

Post-Surgery Tips

Splinting the Toe with a brace or support depending on the type of surgery for a specific period.
Gradual Physical Therapy to restore strength and movement under specialist supervision.
Wound Monitoring to prevent infection.
Pain Relievers and Anti-Inflammatory Medications to reduce swelling and pain.
Follow Doctor’s Instructions to avoid exacerbating the condition or deformity.

Hammer Toe Treatment with Exercises

Exercises are a crucial part of the treatment plan, especially in the early stages or after surgery to strengthen muscles and maintain joint flexibility. Key exercises include:

Finger Extension Exercises
- Description: Straighten the hammer toe and move the joint gently.
- How to Perform:
  - Place the hand on a flat surface with the back of the hand facing up.
  - Slowly lift the hammer toe upwards, keeping the other fingers steady.
  - Hold the position for a few seconds, then gently return the toe.
- Repetitions: 10–15 times, 2-3 times a day.
Rubber Band Exercise
- Description: Strengthen the extensor muscles of the toes using a rubber band.
- How to Perform:
  - Place the rubber band around all the fingers.
  - Slowly open the fingers against the resistance of the band, then return them slowly.
- Benefit: Strengthens muscles and improves movement control.
Warm Water Hand Exercises
- Description: Use warm water to soften the joints before exercise.
- How to Perform:
  - Soak the affected hand in warm water for 5–10 minutes.
  - Afterward, perform gentle extension and flexion exercises within the water.
- Benefit: Reduces joint stiffness and encourages toe movement.
Squeeze Ball Exercise
- Description: Improve finger strength and functionality.
- How to Perform:
  - Use a small rubber or foam ball.
  - Squeeze the ball gently and then release.
- Repetitions: 10–15 times, twice daily.
Stretching Exercises
- Description: Lengthen the muscles and tendons around the joint.
- How to Perform:
  - Using the other hand, gently pull the hammer toe back (straighten it) until you feel a light stretch.
  - Hold the position for 15–30 seconds, then relax the toe.
- Repetitions: 3–5 times, once or twice a day.

Important Tips During Exercise

Do not force the toe to move if there is severe pain.
The exercises should be gentle and gradual based on your capacity.
After surgery, follow physical therapy exercises under a specialist’s supervision to avoid complications.
Combining exercises, physical therapy, and splinting will accelerate healing and prevent further deformity.

Timeframe for Results After Treatment

Exercise and Splinting Treatment
- Mild to Moderate Cases: Initial improvement is usually seen within 4–6 weeks.
- Complete Improvement: Full movement and flexibility may take 2–3 months.
Medication (Pain Relievers and Anti-Inflammatories)
- Pain and Swelling Relief: Usually occurs within a few days to 2 weeks.
- However, medications do not restore the natural shape of the toe or fix the deformity; they are typically combined with exercises and splinting.
Surgical Treatment
- After minor surgery or arthroscopy: Pain improvement typically occurs within 1–2 weeks.
- After tendon repair or realignment surgery: Gradual improvement in movement begins in 4–6 weeks, with full recovery potentially taking 3–6 months.