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Hammertoe and mallet toeBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/hammertoe-and-mallet-toe/DS00480
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Hammertoe and mallet toe are two foot deformities that occur most often in women who wear high heels or shoes with a narrow toe box. These types of footwear may force your toes against the front of the shoe, causing an unnatural bending.
A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe affects the joint nearest the toenail. Hammertoe and mallet toe are most likely to occur in the toe next to your big toe.
Relieving the pain and pressure of hammertoe and mallet toe may involve changing your footwear and wearing shoe inserts. If you have a more severe case of hammertoe or mallet toe, you may need surgery to experience relief.
Hammertoe and mallet toe feature an abnormal bend in the joints of one or more of your toes. Moving the affected toe may be difficult or painful. Corns and calluses can result from the toe rubbing against the inside of your shoes.
When to see a doctor
See your doctor if you have persistent foot pain that affects your ability to walk properly.
Hammertoe and mallet toe have been linked to:
- Certain shoes. High-heeled shoes or footwear that's too tight in the toe box can crowd your toes into a space that's not large enough for them to lie flat. This curled toe position may eventually persist even when you're barefoot.
- Trauma. An injury in which you stub, jam or break a toe may make it more likely for that digit to develop hammertoe or mallet toe.
- Nerve injuries or disorders. Hammertoe and mallet toe are more common in people who have nerve damage in their feet, which often occurs with such medical problems as a stroke or diabetes.
Factors that may increase you risk of hammertoe and mallet toe include:
- Age. The risk of hammertoe and mallet toe increases with age.
- Your sex. Women are much more likely to develop hammertoe or mallet toe than are men.
- Toe length. If your second toe is longer than your big toe, it's at higher risk of hammertoe or mallet toe.
At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.
Preparing for your appointment
If you're having problems with your feet, you're likely to start off by seeing your primary care doctor. In some cases, however, your primary care doctor may refer you to a foot specialist (podiatrist).
What you can do
Your time with your doctor is often limited, so preparing a list of questions will help you make the most of your time together. Some questions you might want to ask your doctor include:
- What's the likely cause of my foot problems?
- Is this condition likely to be temporary or permanent?
- What treatment approach do you recommend?
- Am I a candidate for surgery? Why or why not?
- Are there any additional self-care steps that might help?
Also, don't hesitate to ask questions during your appointment if you're unclear about what your doctor is telling you.
What to expect from your doctor
Some questions your doctor may ask of you include:
- When did you first begin having foot problems?
- How much pain are your feet or toes causing you?
- Where is the pain located?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What kind of shoes do you normally wear?
Tests and diagnosis
Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.
Treatments and drugs
If your toe is still flexible, your doctor may recommend that you change to roomier and more comfortable footwear and that you wear shoe inserts (orthotics) or pads. Wearing inserts or pads can reposition your toe and relieve pressure and pain.
In addition, your doctor may suggest exercises to stretch and strengthen your toe muscles. These may include picking up marbles or a thin towel off the floor with your toes.
If conservative treatments don't help, your doctor may recommend surgery to release the tendon that's preventing your toe from lying flat. In some cases, your doctor might also remove some pieces of bone to straighten your toe.
Lifestyle and home remedies
Wearing proper footwear may ease your foot pain. Low-heeled shoes with a deep toe box and flexible material covering the toes may help. Make sure there's a half-inch of space between your longest toe and the inside tip of your shoe. Allowing adequate space for your toes will help relieve pressure and pain.
Avoid over-the-counter corn-removal products, many of which contain acid that can cause severe skin irritation. It's also risky to try shaving or cutting an unsightly corn off your toe. Foot wounds can easily get infected, and foot infections are often difficult to treat, especially if you have diabetes or poor circulation.
You can avoid many foot, heel and ankle problems with shoes that fit properly. Here's what to look for when buying shoes:
- Adequate toe room. Avoid shoes with pointed toes.
- Low heels. Avoiding high heels will help you avoid back problems.
- Adjustability. Laced shoes are roomier and adjustable.
These additional tips may help you buy the right shoes:
- Buy shoes at the end of the day. Your feet are smaller in the morning and swell throughout the day.
- Don't assume your shoe size hasn't changed. As you age, your shoe size may change — especially the width. Measure both feet and buy for the larger foot.
- Ask for just the right fit. A shoe repair store can stretch shoes in tight spots.
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- Hammer toe. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00160. Accessed Jan. 10, 2013.
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- Malloy A, et al. Mallet toe deformity. Foot and Ankle Clinics of North America. 2011;16:537.
- Barbara Woodward Lips Patient Education Center. Selecting footwear for healthier feet. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.