Foot Health

Hammertoe

Hammertoe is a contracture (bending) deformity of one or both joints of the second, third, fourth or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to nonsurgical treatment.

Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

Causes

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) or neurological changes in the foot that occur over time in some people.

Hammertoes can be aggravated by shoes that do not fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight or poorly designed shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Symptoms

Common symptoms of hammertoes include:

• Pain or irritation of the affected toe when wearing shoes.

• Corns and calluses (a buildup of skin) on the toe, between two toes or on the ball off the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending on their location.

• Inflammation, redness or a burning sensation

• Contracture of the toe

• In more severe cases of hammertoe, open sores may form.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, x-rays may be taken to determine the degree of the deformities and any changes that may have occurred.

Hammertoes are progressive – they do not go away by themselves and usually they will get worse over time. However, some hammertoes progress faster than others. After your foot is evaluated, a treatment plan will be developed.

Nonsurgical treatment

There are lots of treatment options for hammertoe. The severity of your hammertoe will guide the treatment plan. Some nonsurgical treatment options may include exercise, padding corns and calluses, changes in shoe wear, orthotic devices, medications and splinting/strapping.

• Exercise to help straighten the toe and restore muscle balance, may be recommended.

• Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to protect corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful.

• Changes in shoe wear. Avoid shoes with narrow or pointed toes, shoes that are too short, or with very high heels because they force the toes against the front of the shoes. Instead, choose comfortable shoes, square or rounded mouth, with a deep, roomy toe box and heels no higher than two inches.

• Orthotic devices. A custom orthotic device placed in your shoes may help control the muscle/tendon imbalance. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.

• Medications. Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

• Splinting/strapping. Splints or small straps may be applied by the surgeon to help realign the bent toe.

When surgery is needed

In some cases, usually when the hammertoe has become more rigid and painful or when an open sore has developed, surgery is needed. Often, patients with hammertoe may also have bunions or other foot deformities that can be surgically corrected at the same time. To select the best procedure, the foot and ankle surgeon will consider the extent of your deformity, the number of toes involved, your age, your health status, your activity level and other factors.

The recovery time after surgery will depend on the procedure or procedures performed but it can be three to six weeks for healing. During this time, you will wear a surgical shoe and can walk as usual.


• For more information, email us at foothealth242@gmail.com or visit www.apma.org. To see a podiatrist, telephone 325-2996 for an appointment, visit Bahamas Foot Centre on Rosetta Street, or call 394-5824 for an appointment; or visit Bahamas Surgical Associates Centre on Hilltop Medical Centre off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment.

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