What is a hammertoe?

A hammertoe is a toe that is contracted. There are 2 forms of hammertoes; flexible or rigid. The rigid hammertoe is fixed and cannot be returned to a straight toe. A flexible toe can be placed back into its normal alignment.

two feet with advanced hammertoes

Why do hammertoes develop?

Contracted hammertoes develop for one reason – a mechanical over-powering of the tendons on the toes. There are very powerful tendons that attach to the top or bottom of the toes. Some conditions force one set of tendons, the ones on the top or the bottom, to pull a stronger force than the other set. The tendons on the top of the toes are called extensor tendons and the ones on the bottom are flexors. They flex or extend the toes.

So, why is there a situation where one set of tendons overpowers the other?

The answer always goes to the alignment of the bones of the feet. The most common cause for a contracted toe is called “flexor stabilization hammertoe.” This is associated with a foot structure that is in a weakened or what is called over-pronation. The exact reasoning why an over-pronating foot leads to this type of a hammertoe has really never been explained, except to say that the flexor tendons are pulling with a stronger force than the extensor tendons. Eventually, what used to be a straight toe becomes a bent toe, and what was a flexible bent toe, eventually becomes a rigid bent toe.

It is very important to know the underlying cause of the formation of a hammertoe.

It’s like having a flat tire on your car or bike. The flat tire is the symptom, the thing you see, or experience. There is an underlying cause for that flat tire. If you just fill-up the tire with air without fixing the underlying cause, the hole in the tire, the tire will go flat again. It seems so obvious, but the medical community only likes to focus their attention on treating symptoms. Little attention is focused on fixing the underlying cause.

Here is the real reason why flexor stabilization hammertoes occur.

It begins when the ankle bone partially dislocates on the heel bone. This leads to a prolonged weakening of the joints within the foot. The foot is in a weakened pronated position, rather than a strong supinated position. This creates instability within the joints of the foot.

Ligaments are amazing structures that connect from one bone to another.

They have neurosensory detectors that sense strain. Instability within the joint strains the ligament and the sensors are activated. Just like turning on a light switch, the light bulb shines. The switch from the sensors in the ligament sends a signal to the spine that extra support to the joints of the foot is needed. So, the spine sends a signal to the muscles that support that joint with instability to contract. In this case, the flexor muscles are the ones forced to contract. A force happens from the area where the tendon inserts into the toe, pulling the toe back to the heel. The extensor muscles are not contracting and that’s why the balance of tendons pulling on the toes become imbalanced.

This excessive pronation joint instability issue only occurs when standing, walking, or running.

The more active you are, the more contraction there is of the flexor muscles pulling on the toes. Walking is the most common conscious activity of the body. We continue to walk, day after day, and that is why hammertoes never go away but get progressively worse.

Why are hammertoes a “bad thing”?

Contracted bent toes are more than a cosmetic issue. Yes, they can cause pain while wearing shoes or limit the kind of shoes you can wear, but there is a much bigger issue that could happen later in life. Many people develop numbness in their toes. Now we have a potential disaster waiting to happen. The combination of a contracted, numb toe could lead to the development of an ulcer to the toe. The ulcer could quickly lead to bone infection and amputation of the toe. We are not trying to use scare tactics and not everyone with hammertoes has this issue.

What is the best form of treatment?

The best form of treatment is to eliminate the underlying imbalance between the extensor and flexor tendons. Applying a pad to the toe or even wearing wider or open-toed shoes is not a treatment. They are subtherapeutic forms of treatment – the contracted toe will continue to get worse. Millions of toes are operated on every year in an attempt to straighten the toe. Surgeons will cut tendons of the toe and remove a section of the joint. The surgeon will be very pleased because the toe will look straight. The only issue is that the underlying cause of the hammertoe is still present. The ankle bone is still partially dislocating on the heel bone. The joint instability within the foot is still present and the ligaments are still sending the signal to the spine to cause the flexor muscles to contact. It is just a matter of time until the surgically realigned toe becomes a hammertoe again. That’s because the cut tendons will heal back together and the muscle will once again aggressively pull the toe out of alignment. Many surgeons will then insert a toe implant, wire or screw, in an attempt to fuse the joint to straighten the toe. The biggest problem is that there is still a pretty good chance that the toe will bend again. The bottom line, it is important to fix the underlying cause, and the sooner the better. Imagine if the ankle bone was stabilized on the heel bone with HyProCure early in life. The tendons will be pulling on the toes in a balanced manner. The person would not have had all of the potential issues associated with those hammertoes. No published evidence proves HyProCure will straighten your toes, but this is a comment that has been told to us. It also makes perfect sense. If the ligaments don’t get strained, then the strain sensor is not activated and the flexor muscles are not having to contract excessively.

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