Hammer Toes and Neuromuscular Disease

Hammer Toes and Neuromuscular Disease
Technically referred to as hammer toe deformity, hammer toe is caused by contractures in the joints of the toe. Hammertoe is most common in the second toe, but can affect all of the four smaller toes. The affected toe or toes turn under into a claw-like position.

More specifically, the middle joint of the toe becomes bent and the end part bends underneath. The affected joints are called the metatarsophalangeal (MTP) and distal interphalangeal (DIP). Early in the process, the joint may still be flexible, but over time usually becomes rigid. Hammer toes can cause pain in the joint. Skin problems such as corns, calluses and blisters can occur.

In neuromuscular diseases such as Charcot Marie Tooth (CMT) and Friedreich’s ataxia, hammer toe occurs frequently. The uneven pulling on the muscles, tendons, and joints caused by neuropathy causes foot deformity, including hammer toes and high arches (pes cavus) or less commonly low arches (pes planus).

Hammer toe occurs in the general population and with other medical problems, including rheumatoid arthritis, stroke, cerebral palsy, and degenerative disc disease, as well. Hammer toe occurs more often in women than men. Tight fitting shoes and high heels can cause hammer toes. In children, wearing shoes that have been outgrown can cause hammer toes.

Changes in the feet or toes should be evaluated by your physician or pediatrist. Physical examination of the toes and foot will generally be adequate for diagnosis, but an X-ray may be ordered as well.

Treatment most often includes avoiding high heels and poorly fitting shoes. Choosing a shoe that has a wide toe box with plenty of room for toes can help. Using soft insoles and corn pads and felt pads may relieve pressure. Gentle stretching exercises, taping or splinting affected toes, and/or orthotic inserts might be recommended by your physician or pediatrist. In severe cases where hammer toes cause severe pain or difficulty walking, surgery may be needed to straighten affected joints.


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