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Q
Hampered by Hammertoes?

I have developed a hammertoe. Is there anything I can do to correct it? I don't want surgery. I have been taping it down to avoid it rubbing on my shoe, but it still is red and hurts.

A
Answer (Published 9/22/2010)

A hammertoe is a toe that is bent at the middle joint, curled under, and looks claw-like. It can cause foot pain and affect your ability to walk properly. Corns or calluses usually develop on top of the toes as a result of friction against footwear. At first, a hammertoe may remain flexible, but over time, it can become permanently stiff. The deformity is usually caused by shoes that are too tight in the toe area or (in women) by wearing high heels. Some cases appear to be hereditary.

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The most important thing you can do for a hammertoe is to wear comfortable shoes that don't put pressure on your toes. Make sure that your shoes fit properly. (Your right and left foot may not be the same size, so be sure to have both of them measured.) Remember that shoe size can change over time - feet tend to get wider as we get older - so don't assume you know what size you should be wearing. When buying shoes, make sure that there's a half inch clearance between the inside tip of your shoe and your longest toe. (Another technique, taught to shoe sales personnel, is to be sure that the distance is at least the width of the client's thumbnail.) In addition, simple exercises, such as picking up marbles with your toes, and stretching your toe muscles can help. You can take an over-the-counter nonsteroidal anti-inflammatory drug for pain and use pads to prevent your shoes from rubbing on your toes.

In addition to more comfortable shoes, you could also consider wearing orthotics, shoe inserts that can help correct improper foot movement and alignment. Phillip Vasyli, a well known podiatrist and expert on foot biomechanics, recommends seeking out quality over-the-counter orthotics with firm support that can help restore feet to their natural position. He notes that these products can be as effective (and more affordable) as custom orthotics or surgery.

Dr. Vasyli also suggests wearing sandals or other shoes that don't cover the toes because they can better accommodate your feet and eliminate any friction between the shoe and the top of the toes.

If these methods don't work, you may have to consider surgery, usually a simple outpatient procedure. If the toe is still flexible, this involves making an incision to release a tendon, allowing the toe to straighten. If not, toe-straightening surgery may be necessary, which requires cutting or realigning tendons and removing pieces of bone that may be preventing the toe from straightening.

Andrew Weil, M.D.

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