Did you know that one foot contains no fewer than 27 different bones, 33 joints and more than 100 muscles, tendons and ligaments? “When someone comes to us, we have to find out exactly what is wrong,” says Arne Burssens, orthopedic surgeon in foot and ankle surgery at Ghent University Hospital. Yet it is immediately quite clear what is wrong when your middle toe is in a flexion position and the last one is in an extended position in the shape of a hammer: hammer toes.
How do hammertoes develop? “The majority of hammer toes occur due to wear and tear. The lower ligament, which forms the transition between the toe and the foot, does not provide sufficient support. This causes at least one toe phalanx to rise in a flexed position. This mainly occurs in people with standing jobs that put a lot of strain on their feet, such as teachers.”
The complaints usually occur from the age of 50, but the toe position slowly but surely begins to deform in the preceding years.
Narrow shoe tips can also be a cause. And heels can put serious excess pressure on the ligaments, which are looser in women anyway.
Grasping movement
But the abnormality can also be congenital. Because one of the tendons is shorter or because your foot bones adopt a different position. “By increasing the tension on the flexor or extensor tendon for years, you will eventually end up in the danger zone.” There may be a hereditary factor in this group, although no specific gene for hammertoes has yet been identified. “Yet we often see that the condition also occurs in other family members.”
Of course, there is never a guarantee, but you can do something to keep your feet flexible for as long as possible. For example, it helps to regularly stretch the calf muscle and to strengthen the foot muscles that keep the arch of the foot straight through physiotherapy. “One of the best exercises for the sole of the foot is the downward gripping movement, as you unconsciously do when walking on sand,” Burssens explains. “That is why a barefoot walk on the beach can be beneficial for people with (predisposition to) hammertoes.”
You can also wear wide shoes, arch supports or even ‘forefoot relief footwear’, from brands such as Xsensible and Hoka, or some sports models from Nike, such as the ZoomX. “The same principle is actually used as with a rocking chair. The rocking sole under the foot will ensure that you roll off in the middle part instead of on the forefoot, sparing your toes.”
An operation
Custom-made silicone splints to place between the toes and straighten things out in your shoes can also have a preventive effect. “A combination of all these measures is often the most effective,” says Burssens.
Have you tried those tips, but the problem is not solved? Then surgical intervention can be performed. “For hammer toes that are still more or less flexible, we can place the toe tendon in a different location through surgery: a tendon transfer, as it is called.” This way, the overactivity of the flexor tendon is stopped.
“On the other hand, are the hammertoes already completely stiff? We will then loosen the tendons, shorten the joint and insert a pin into the affected toe or toes to keep them straight again.” After the operation, walk around for at least four weeks in specially adapted shoes that avoid pressure on the toes.
