HAMMERTOES
DESCRIPTION
Hammertoes are a contracture of the toes as
a result of a muscle imbalance between the tendons on the top
and the tendons on the bottom of the toe. They can be flexible
or rigid in nature. When they are rigid, it is not possible to
straighten the toe out by manipulating it. Frequently, they develop
corns on the top of the toe as a result of rubbing on the
shoe. They may also cause a bothersome callous on the ball
of the foot. This occurs as a result of the toe pressing
downward on the bone behind the toe. This area then becomes
prominent and the pressure of the bone against the ground
causes a callous to form.
They tend to slowly get worse with time
and frequently flexible deformities become rigid. Treatment can
be preventative, symptomatic or curative.
Preventative treatment of hammertoe is
directed toward the cause of the deformity. A functional orthotic
is a special insert that can be prescribed by your podiatrist
to address the abnormal functioning of the foot that causes the
hammertoe. Functional orthotics can be thought of as contact
lenses for your feet. They correct a number of foot problems
that are caused by an abnormally functioning foot. Our feet,
much like our eyes, change with time. Functional orthotics slow
down or halt this gradual change in the foot. Often when
orthotics are used for flexible hammertoes, the toes will
overtime straighten out and correct themselves. Calf stretching
exercises are also helpful. Calf stretching can help to overcome
part of the muscle imbalance that causes the hammertoe.
Symptomatic treatment of hammertoes consists
of such things as open toed shoes or hammertoe pads. There
are over the counter corn removers for temporally reducing
the painful callous often seen with the hammertoe. These
medications must be used with caution. They are a mild acid
that burns the callous off. These medications should never
be used for corns or callouses between the toes. Persons
with diabetes or bad circulation should never use these products.
Curative treatment of hammertoes varies
depending upon the severity of the deformity. When the hammertoe
is flexible, a simple tendon release in the toe works well.
The recovery is rapid often requiring nothing more that a
single stitch and a Band-Aid. Of course if several toes are
done at the same time, the recovery make take a bit longer.
For the surgical correction of a rigid hammertoe, the surgical
procedure consists of removing the damaged skin where the
corn is located. Then a small section of bone is removed
at the level of the rigid joint. The sutures remain in place
for approximately ten days. During this period of time it
is important to keep the area dry. Most surgeons prefer to
leave the bandage in place until the patient’s follow-up
visit, so there is no need for the patient to change the bandages
at home. The patient is returned to a stiff-soled walking shoe
in about two weeks. It is important to try and stay off the foot
as much as possible during this time. Excessive swelling of the
toe is the most common patient complaint. In severe cases of
hammertoe deformity a pin may be required to hold the toe in
place and the surgeon may elect to fuse the bones in the toe.
This requires several weeks of recovery.
Complications associated
with the surgery are infection, excessive swelling leading to
delays in healing and potential deviation of the toe. If excessive
bone is removed during the surgery, the toe may be a bit floppy.
The toe always has a floppy feeling for several weeks following
the surgery. This is normal and generally not permanent.
If pinning the toe is not required during the procedure,
then the surgery could be preformed in the doctor’s office
under a local anesthesia. Some patients prefer the comfort of
sedation during the surgery and if this is the case or if a pin
must be placed, then the surgery could be preformed in an outpatient
surgery center.
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