Hammer toes are classified according to severity and mobility:

1. Flexible hammer toes:
   • The misalignment is still reversible, and the toe can be passively straightened.
2. Fixed hammer toes:
   • The misalignment is permanent, and the joint can no longer be straightened.
3. Secondary hammer toes:
   • The deformity occurs in combination with other foot misalignments such as hallux valgus or splayfoot. 

The causes of hammer toes are varied and include:

• Inappropriate footwear:
  • Tight, pointed, or high-heeled shoes push the toes into an unnatural position and promote misalignment in the long term.
• Foot deformities:
  • A splayfoot, flatfoot, or hallux valgus increase the pressure on the toes and favor the development of hammer toes.
• Neurological disorders:
  • Disorders such as poliomyelitis or diabetic neuropathy can impair the balance of the foot muscles and lead to misalignments.
• Genetic predisposition:
  • A familial accumulation indicates a genetic predisposition.
• Trauma:
  • Injuries to the toes or foot can permanently change the anatomy of the toes.

The symptoms vary depending on the severity and duration of the misalignment:

• Pain:
  • Pain occurs primarily when pressure is applied to the affected toe.
• Pressure points and corns:
  • Painful skin thickening occurs due to friction against the inside of the shoe.
• Restricted movement:
  • In fixed hammer toes, the mobility of the affected toe is severely restricted.
• Aesthetic impairment:
  • The visible deformity is often perceived as bothersome.
• Gait changes:
  • To avoid pain, affected individuals often develop an altered gait pattern.

The diagnosis is based on a thorough medical history, clinical examination, and imaging techniques:

• Medical History:
  • The doctor inquires about the complaints, the duration of symptoms, and possible triggering factors such as footwear or foot deformities.
• Clinical Examination:
  • Checking the position of the toes, mobility, and sensitivity to pressure.
• Imaging Techniques:
  • X-ray: Depiction of bony changes and the severity of the deformity.
  • Ultrasound: Examination of soft tissue structures such as tendons or ligaments.

Conservative Therapy

In early stages or with flexible hammer toes, conservative measures are often sufficient:

• Shoe Adjustment:
  • Use of wide, comfortable shoes with enough space for the toes.
• Orthopedic Insoles:
  • Support of the arch to relieve pressure on the toes.
• Toe Spreaders or Pads:
  • Prevent friction and relieve pain in mild misalignments.
• Physiotherapy:
  • Exercises to strengthen foot muscles and improve mobility.
• Pain Therapy:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.

Surgical Therapy

For fixed or painful hammer toes, surgical correction is necessary:

• Tendon Lengthening:
  • Lengthening of the shortened flexor tendons to restore toe mobility.
• Arthroplasty:
  • Removal of part of the affected joint to straighten the toe.
• Arthrodesis:
  • Stiffening of the middle joint for permanent stabilization of the toe.

To prevent hammer toes, the following measures are recommended:

1. Suitable footwear: Wearing shoes with a wide toe box and flat sole.
2. Regular foot exercises: Exercises to strengthen and increase the flexibility of the toe muscles.
3. Avoiding overstrain: Limiting the use of high-heeled or pointed shoes.
4. Walking barefoot: Promoting natural foot function on soft surfaces.
5. Early treatment: Immediate therapy at the first signs of pressure points or deformities.