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Hammertoes and Blister Prevention

by Rebecca Rushton 2 Comments

What are hammertoes? What causes them? What makes them susceptible to blisters? Can you get rid of hammertoes?

Despite the symptoms, people make the mistake of ignoring their misshapen toes, making the situation even worse with corns, callouses and blisters on the tops of toes. So, in this blog post, I am going to give you a deeper understanding of the causes of hammertoes and some remedies that would alleviate the pain.

Hammertoes
Hammertoes - notice the prominent joints on the middle toes (Triad Foot And Ankle Center)

 

What is a hammertoe?

A hammertoe is one of several toe deformities (see image below). Hammertoes can occur on any of the three middle toes. Most often, it’s the one next to your big toe.

Hammertoes, claw toes and mallet toes
Hammertoe, claw toe and mallet toe deformities

 

Hammertoe causes - What causes toes to bend over?

Let’s talk collectively about what causes the three toe deformities in the picture above.

Toes consist of three bones – just like your fingers (except your big toe has two bones, like your thumb). Normally, all three bones sit straight and in line – just like if you hold your finger out straight out. They sit straight thanks to the support of ligaments and the fine balancing act between the pull of two pairs of tendons.

  • Now bend your finger – See how the two joints stick out and become obvious. This is exactly what happens when you have a claw toe. The toe bends over and the two joints become prominent.
The middle toe is a clawed toeClawed middle toe (Allen Foot Doctor)
  • Now bend only the first joint of your finger and keep the end joint straight. This is what happens when you have a hammer toe. The toe bends over and the first joint becomes prominent.

Hammertoes (Shutterstock)

  • Now keep the first finger joint straight and just bend the end joint. This is what happens when you have a mallet toe. The toe bends over and the end joint becomes prominent.

Mallet toeMallet toe (London Foot and Ankle Clinic)


When you wear a shoe and start to walk and run, it’s easy to imagine the prominent toe joints getting pushed, pinched and rubbed by your shoe.

hammertoes and claw toes rubbing
Bandaged hammer, claw and mallet toes

 

Hammertoes, claw toes and mallet toes start when there is an imbalance to the joint between the first two toe bones. Stubbing your toe, someone treading on it, poor shoe choices, developing a bunion, injury… any of these scenarios could cause a change in the pulling power of one tendon over the other. This destabilisation leads to a gradual cascade of events culminating in the toe buckling. It usually happens gradually and gets worse as the months and years pass. Diseases also play a role in the cause of toe deformity - people dealing with diabetes, arthritis and neuromuscular diseases are at higher risk of misshapen toes.

In my experience, the most common causes of hammertoes and other toe deformities are bunions, tight calf muscles and a history of wearing ill-fitting shoes. Ill-fitting shoes, in width or length, are a common cause because day in, day out, they either change toe posture such that it buckles, or they negatively affect the pull of tendons. Long term, muscles, tendons and ligaments become increasingly tight one one side of the joint and stretched on the other, holding the toe in this hammered, clawed or mallet position.

Bunion causing hammertoe
Hammertoe right foot cause by bunion. As the big toe slides across, the 2nd toe is pushed upwards. (Cleveland Clinic)



Another factor is toe length, and how closely the curve of your toes match the curve of your shoe. This will become relevant if you wear shoes that are too small for you; or too big and loose such that your foot slides forward and hits the end of your shoe. Toes shouldn’t come into contact with the end of your shoe - at all! You should have the width of your thumb between the end of your longest toe (whichever toe that is) and the end of your shoe. But many people neglect this.

It’s normal for the 2nd toe to be a little bit longer than the big toe. This alone does not predispose you to hammer toe, claw toe or mallet toe deformity. In fact, this arrangement fits closest to the shape of most shoes. Take a look at the image below.

Which toe is longest

There is a large variability in which toe is longest. Which of your toes is longest? Does the curve of your toe lengths match the shape of your shoe? You could be putting yourself a t risk of developing a hammertoe, claw toe or mallet toe.

 

But sometimes one toe can be especially long so as not to fit the rounded parabola of your shoe. Less commonly, the third or fourth toe can be especially longer. These long toes are the ones most likely to be affected to developing a toe deformity - if your shoes don’t fit it properly. Remember the rule of thumb for shoe-fit.

Very long second and third toes
Hammertoes on the 2nd, 3rd and 4th toes. The second toe is much longer than the big toe. And if held out straight, the third toe would be longer than the big toe too. This almost certainly wouldn’t match the shape of the shoe. (MedicineNet)

 

If you don’t have enough room at the end of your toebox, your toe will be impacted. Similarly, if your shoes are too loose and you allow your foot to slide forward and your toe hit up against the end of your shoe, your toe will buckle.

 

Hammertoes and other toe deformities come in two categories:

Flexible – In the earlier stages of a toe deformity, the toe is bent out of shape but the joints are still flexible and can be straightened.

Rigid – In the later stages, as the toe continues to assume this buckled position, ligaments and tendons tighten and the bones change shape. The joints become too stiff and inflexible to be straightened, even temporarily.

How to treat claw toe and hammer toe symptoms

Hammertoes, claw toes and mallet toes can lead to painful corns, callouses and blisters in two areas:

1. The top of the toe where the shoe presses down on the prominent joint(s)

  • Naturally, the more shallow the toebox of the shoe, the more painful this area will become. So choose a shoe with a deep toebox.
  • Gel toe sleeves can cushion the prominent joints and protect them from rubbing forces.
  • Your podiatrist can make a toeprop to lift the shoe off the prominent joint and save the skin from trauma.
Gel toe sleeves

 

2. The tip of the toe which has now become weightbearing

  • The tip of the toe isn’t designed to bear weight as it doesn’t have the natural fatty padding to tolerate this. A gel toe cap can be used to cushion the tip of the toe.
  • You can wear a toeprop to prevent the toe from bending over so much. Toeprops can be custom made by your podiatrist. Toeprops will work if your claw toe or mallet toe is at least partially flexible. If it is fixed, the toeprop may in fact lift your toe up and rub the top of the toe more!
  • If you are dealing with rigid claw toes and mallet toes and finding it difficult to get relief, then you may need surgery to correct the condition.

 

Gel toe caps

 

pre-made toeprop
Off-the-shelf toeprops take up space under the toes so the toes are less able to bend over. (ResearchGate)
Off-the-shelf toeprop
Off-the-shelf toeprops for hammertoe, claw toe and mallet toes consist of a firm foam pillow with an elastic loop that goes over one toe to hold it in place. Be careful the elastic doesn't get too tight!

 

Custom made toe prop
Custom made toeprop by a podiatrist. This will stop toes 2 and 3 from bending over so much. This will prevent blisters, corns and callouses on the tips of the toes. https://youtu.be/lL4_E_DlCgc

 

While none of these treatments will reverse your hammertoe, claw toe or mallet toe (except surgery), when used correctly and frequently enough, toeprops and gel toe protectors will keep your corns, callouses and blisters at bay. If you’re in any doubt, be sure to see a podiatrist to get advice on how to minimise the limiting effect of your misshapen toe on your lifestyle.

 

Protect your feet from hammertoes, claw toes and mallet toes

As the old saying goes, prevention is always the best cure. While easier said than done, always wear sensible shoes that will accommodate your toes without impinging them. This is the first step in preventing toe deformities. But at the end of the day, nobody purposely subjects their feet to the types of trauma that can lead to altered toe shapes. I’ve seen hammertoes caused by horses treading on toes, claw toes caused by cars running over feet and even a mallet toe caused by a falling mobile phone! 

Consult a podiatrist if you suspect you’ve got a hammertoe, claw toe or mallet toe developing as there may be something they can do to slow the progression down, alleviate your symptoms and prevent your blisters.




Rebecca Rushton
Rebecca Rushton

Author

Podiatrist, blister prone ex-hockey player, foot blister thought-leaderauthor and educator. Can’t cook. Loves test cricket.


2 Responses

Rebecca Rushton
Rebecca Rushton

July 25, 2019

Hey Genny, the gel toe sleeves are a great choice. With one on the 2nd toe, you’ll be protecting a) the top of the 2nd toe [the hammertoe] b) the 1/2 interdigital space c) the 2/3 interdigital space. Let us know how you go.

Genny Bolton
Genny Bolton

July 25, 2019

Rebecca – Great info, thanks so much. I’ve kicked up my walking routine and, of course, problems with toes are starting. I need to separate as blisters are forming interdigitally. I’ve tried taping #2 and #3 together. This irritated the big toe and #4 which caused blisters on both and blisters also formed at the bottom of taped #2. I’m going to try the gel toe sleeves and caps and going to look into fixomull and lucotape. I have bunions and toes #2 are the really unhappy ones. One of them is getting a little hammery. I’ve had problems with the metatarsal pad hurting, but new orthotics help. Thanks, again. Genny

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