Pediatric Hammertoes DEFINITION A deformity of the toe in which the toe is bent downward like a claw - grasping at the ground. CAUSES, INCIDENCE AND RISK FACTORS: Hammer toes are usually a progressive dissorder, which initially affects the second toe, although any toe may be affected. The toe assumes a claw like position that may occur as a result of repeatedly grasping at the ground to stabilize an unstable (usually flat or pronated) foot. Some claw or hammertoes are caused from the pressure from a bunion, or other outside deforming forces such as shoes. A corn on the top of a toe and a callus on the sole of the foot may develop which makes walking painful. The causes of this condition are frequently congenital. However, improper fitting shoe gear should be ruled out, especially in a child who seems to outgrow their shoes rapidly. SIGNS AND SYMPTOMS A toe that is curling downwards and grasping at the ground like a claw. A thickened area of skin (a corn) forming on the top of a toe. Pain and or callus formation on the sole of the foot - near the ball of the foot under the contracted toes. PREVENTION Logical dictates a prudent approach of control the outside infuences first. Proper fitting shoe gear is important - avoid wearing shoes that are too short or narrow (check children's shoe sizes frequently, especially during periods of rapid growth.) In children with advanced flat feet one should consider at a minimum a motion control(anti-pronation) running shoe. The ultimate control would come from a small controlling device known as an orthotic - a custom cast is taken of the childs feet in their neutral position (not pronated or flattened) and custom devices are made to an exact replica of the childs neutral foot. TREATMENT Treatment of mild cases may include: Manipulation and splinting of the affected toe(s). The protruding joint(s) can be protected with special padding. Corrective footwear, or other foot (orthotic) devices. Special exercises may be helpful. Severe deformity requires an operation to straighten the joint. EXPECTATIONS (prognosis): If treated early, surgery may be avoided,which can reduce the associated pain and difficulty with walking. Most importantly if the right preventative therapies are initiated, further progression of the deformities and other associated foot problems may be avoided. CALL YOUR PODIATRIST (FOOT SPECIALIST) IF: The hammer toe is present, espcially if pain gets worse or difficulty walking occurs, for instructions on the best treatment. copy right 2000