Hammer Toe Vs Bunions – What’s The Difference?

Our feet provide a steady base that carries the weight of our entire body. They absorb the shock of our footstrikes, as our feet land with a force that easily exceeds our body weight and they propel us forward.

When we look at the structure of our feet, it’s something to marvel at. There are 33 joints and 26 bones in one foot—one less bone than in our hands, and the feet have more joints—and over a hundred tendons, ligaments and muscles.

Our feet are flexible and the muscles, joints and soft tissues let us perform activities like standing, running, jumping, walking or using gym equipment like the stationary bike or elliptical machine.

Our toes are more important as you may think, as they provide balance, support, posture and help to propel you forward. But our feet are susceptible to foot conditions that can cause inflammation and pain, such as gout.

Two common foot conditions that affect a person’s gait as well as their balance—which can increase your risk of injury—are hammer toes and bunions.

Let’s take a look at what hammer toes and bunions are, their causes and what treatments are available for both.

Bunions

The technical terminology for a bunion is Hallux Abducto Valgus. Although a bunion starts out small, it’s progressive and will continue to get bigger over time.

When some of the bones in the forefoot move out of place, the tip of your big toe is pushed towards the other toes on your foot. This misalignment causes the metatarsophalangeal joint—at the base of your big toe—to stick out and results in a new bony growth.

Every time you take a step the metatarsophalangeal—MTP—flexes, and this constant movement causes the bunion to grow in size. As the bunion develops, you’ll start to notice a bump developing on the outside of the base of the big toe. The skin around the bump can become red and the joint can also be swollen.

You may notice that the skin has hardened underneath the foot by the base of the joint, or that the skin appears to be thicker. Some people may experience pain that comes and goes, while other people may experience ongoing pain. It may have a burning sensation, but some people have also experienced numbness around the area of the bunion.

The bunion will continue to push the big toe into the neighbouring toe and it can often go under or over the toe next to it. This leads to the development of corns and calluses, where the toes rub against each other. You may find that trying to move the big toe is painful or that the movement is restricted.

When you have a bunion, it can also lead to the bursa next to it—a tiny fluid-filled sac that provides cushion and reduces friction—becoming inflamed. This will create additional swelling, pain and redness around the area.

The inflammation of the bursa sac between bones, joints and tendons is known as bursitis. It can impact many different joints (including knee bursitis).

It’s important to note that bunions are not formed from an outgrowth of blisters that were left untreated. This is a myth.

Hammer Toes

A hammer toe forms when there’s a muscle imbalance in the foot and the toe is forced into a downward position for extended periods of time. This causes an abnormal bend in the proximal interphalangeal—middle joint—and can affect any of the smaller toes—never the big toe—but most often occurs in the second toe.

When a hammer toe first begins to form, it’s still flexible and at this point you may still be able to straighten it out. If left untreated, over time the toe will lose its flexibility and become rigid, making it difficult to move even if you’ve taken your shoes off.

As the toe becomes permanently fixed in its position, your doctor may recommend either joint resection or a fusion to realign and straighten the toe.

Hammer toes make it difficult for shoes to fit properly and often the shoe will rub up against the affected toe. This can lead to calluses and blisters forming on the toes, which could also lead to an infection or open wound on the toe.

Bunions

What causes a bunion?

While the exact cause of a bunion developing is not known, it’s believed that bunions are caused by a number of factors. One of these factors may be the mechanical structure of your foot that you inherited. This means that the shape of your foot may put you at a higher risk of developing a bunion.

If you have flat feet, muscle imbalances or very flexible ligaments, then these could contribute to a person developing a bunion. Overpronation can lead to uneven weight distribution in the foot, which can lead to the joint becoming unstable, potentially causing a bunion to develop.

Bunions can be caused by wearing shoes that have pointy toes, which crowds the toes together and places the big toe under pressure, causing the misalignment of the big toe.

High heel shoes would place a lot of pressure on the ball of the foot and often there’s not enough space for the toes to splay naturally, which can cause a bunion. If your shoes don’t fit you properly—too short or too tight—this could cause your big toe to move out of its natural position, leading to a bunion.

Different types of arthritic conditions, like rheumatoid arthritis, can cause a bunion to form. If you suffer from these conditions, it’s good to wear proper shoes for arthritis.

Conditions like gout or other conditions that cause the inflammation of the joint in the foot can also lead to a bunion forming.

Bunion treatments

Bunions won’t just go away, but you can manage them at home and prevent the bunion from getting bigger.

One of the first steps you should take is to change your shoes. Look for shoes that have a spacious and deep toe box so that you can wiggle them without the shoe touching them. This will also prevent corns and calluses from developing on the top or on the soles of your feet.

Choose shoes that have a zero drop—no elevated heel—as this will prevent your toes from sliding forward in the shoe and placing pressure on the ball of your foot. This applies to your slippers as well as shoes.

Make sure that the shoes that you choose have adequate arch support, as this will help to distribute the weight evenly and take pressure off the ball of the foot. If your shoes don’t have enough arch support, then invest in a pair of inserts or gel-filled pads that will provide enough support. Sandals for bunions should also have good support.

You can also get a bunion pad or pair of bunion socks that will help to reduce the pressure on the affected toe, but make sure that it’s not constricting the big toe. If you feel self-conscious, there are ways to cover up bunions when you go out.

Using a toe separator between your big toe and second toe can help to provide pain relief and help straighten your toe while you’re wearing it. This would be best during the early stages when the bunion is forming.

Toe separators help to realign the toe to its natural position, which increases the production of synovial fluid. This helps to lubricate the joint, which allows it to move more easily and with less pain.

Apply ice to the bunion a few times a day for 20 minutes, as this will help to reduce the inflammation. For pain management, you can use over-the-counter medications like iBuprofen or acetaminophen. Some medical practitioners may give you a cortisone injection to help manage the pain.

Massage the bunion gently a few times a day and include foot exercises like toe yoga. You can also include toe exercises like:

  • Toe point and curl: Sit with your foot above the floor—about 6 inches—then slowly point and curl your toes. Try and do this 20 times in a row two to three times.
  • Spread your toes: Keep your foot flat on the ground and then using your foot muscles, spread your toes as far apart from each other as you can—without pain or discomfort. Try doing this 20 times as well.
  • Single-leg Calf Raises: Cross one ankle behind your other foot, then balance yourself by holding onto a surface or placing your hand on the wall. Keep your toes and ball of your foot on the ground and lift the heel of your foot off the ground as high as you can.

If you’re experiencing severe foot pain when you’re walking and you’re wearing flat, spacious and comfortable shoes, then you should see your doctor. Be prepared for them to recommend bunion surgery.

Do bunions get worse with running?

When you’re running—especially long distances or even half marathons—it can be particularly painful if you have a bunion. Runners who overpronate and who run in shoes that don’t fit them properly will aggravate the bunion.

Running in the wrong shoes will not only make the bunion worse, but it can lead to other foot conditions. This could see your running come to a halt while you’re having to treat the other conditions as well.

Should you run if you have bunions?

Runners can still run even if they have a bunion, but they’re going to have to make sure that they’re wearing the right pair of running shoes.

If the shoe continues to place pressure on the bunion or rubs against the bunion, this won’t just interrupt the workout, but it will cause other foot conditions.

Going down to a specialty store and having your feet measured will ensure that your running shoe will fit you properly. This may require you to get a shoe that’s between a 2E or 4E.

While you’re there, have a look at how severe your pronation is, as this may require that you get a motion control or stability running shoe. Fortunately, the specialty store should have those shoes in your size.

When you go for a run in your new shoes, run a short distance and slowly increase the mileage. This will allow you to test the new shoes and allow your feet to adapt to them. If you notice any pain then you should stop and take action immediately.

Hammer Toes

What causes a hammer toe to form?

All of the smaller toes have 3 joints—metatarsophalangeal, proximal interphalangeal and distal phalangeal joint—while the big toe only has two joints. When the muscles, ligaments and tendons that surround the middle joint—proximal interphalangeal joint—become weak and are no longer to keep the toe straight, this causes the toe to bend at the middle joint.

This is often caused by shoes that don’t fit properly, like shoes that are too short or too tight. But hammer toes can also be caused by other conditions like arthritis, diabetes or peripheral nerve damage. If you’ve broken or fractured your toe—traumatic toe injuries—can lead to developing hammer toes.

How can I avoid getting a hammer toe?

One of the best ways to prevent hammer toes is to make sure that you’re wearing shoes that fit your foot shape. As we get older our feet change shape, and you should get your feet measured—width and length— to ensure that the shoe doesn’t fit too snugly.

Include foot exercises into your daily routine, as this will help to strengthen the muscles in the foot. This will help to keep them supple and prevent the contraction of the muscles that lead to hammer toes.

Check your feet frequently and treat them to a massage on a regular basis.

Treatment for a mild hammer toe

If your hammer toe is still flexible then the first thing you should do is change your shoes, and not just your running shoes.

Get shoes for hammer toes that have good arch support for your foot shape, a wide, deep toe box with either minimal elevated heel or no heel—zero drop. This will allow your toes to splay naturally and return to their natural alignment.

Sandals for hammer toes can be helpful if you want something less restricting than shoes to wear on your feet. Like with shoes, make sure they have arch support and a wide toe box.

If your shoes don’t provide adequate arch support then invest in insoles for hammer toe—you can buy these over the counter—or go see your doctor have custom orthotics made. You can also use rubber or silicone toe separators, as they will help to gently push your toes back into alignment. Some people have found hammer toe socks to treat this condition

Gently stretch the affected toe several times a day and include foot exercises that will help to develop the muscles in your foot. You can put a towel on the floor and, using your toes, scrunch it up from the bottom until you get to the top. Taping for hammer toe may also help.

Can you run with a hammer toe?

You can run with a hammer toe, especially if it’s not causing any discomfort or pain during or after your run.

If you’ve changed your running shoes to a pair that has a deep, wide toe box, this would prevent the shoe from rubbing against your toes which could cause discomfort while you run. You can also look at adding a metatarsal pad or an insole to your shoe, which would help to alleviate any pressure that could be placed on the hammer toe.

Crim, Julia R. “Imaging Anatomy: Knee, Ankle, Foot” 2018. https://www.sciencedirect.com/topics/medicine-and-dentistry/metatarsophalangeal-joint

Cleveland Clinic. “Bursitis” Last Reviewed May 29, 2020. https://my.clevelandclinic.org/health/diseases/10918-bursitis

Healthline. “Proximal phalanges (foot)” Last Reviewed January 20, 2018. https://www.healthline.com/human-body-maps/proximal-phalanges-foot#1

Konstantakos, Emmanuel. “How Do Synovial Joints Work?” Last updated May 13, 2016. https://www.arthritis-health.com/types/joint-anatomy/how-do-synovial-joints-work