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Hammertoes

Hammertoes

What Is Hammertoe?
Hammertoe is a contracture
(bending) 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
progressively 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 non-surgical 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) changes in the foot that
occur over time in some people.

Hammertoes may be aggravated by shoes that don’t fit properly. A
hammertoe may result if a toe is too long and is forced into a cramped
position when a tight 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 of the foot. Corns are caused by constant friction
against the shoe. They may be soft or hard, depending upon 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, the foot and ankle surgeon may take x-rays to
determine the degree of the deformities and assess any changes that may
have occurred.

Hammertoes are progressive – they don’t go away by themselves and
usually they will get worse over time. However, not all cases are alike –
some hammertoes progress more rapidly than others. Once your foot and
ankle surgeon has evaluated your hammertoes, a treatment plan can be
developed that is suited to your needs.

Non-surgical Treatment
There is a variety of
treatment options for hammertoe. The treatment your foot and ankle
surgeon selects will depend upon the severity of your hammertoe and
other factors.

A number of non-surgical measures can be undertaken:

Padding corns and calluses. Your foot and
ankle surgeon can provide or prescribe pads designed to shield 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. Consult
your surgeon about this option.
Changes in shoewear. Avoid shoes with
pointed toes, shoes that are too short, or shoes with high heels –
conditions that can force your toe against the front of the shoe.
Instead, choose comfortable shoes with a deep, roomy toe box and heels
no higher than two inches.
Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.
Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
Medications. Oral nonsteroidal 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 realign the bent toe.

When Is Surgery 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 have bunions or other foot deformities
corrected at the same time. In selecting the procedure or combination of
procedures for your particular case, the foot and ankle surgeon will
take into consideration the extent of your deformity, the number of toes
involved, your age, your activity level, and other factors. The length
of the recovery period will vary, depending on the procedure or
procedures performed.

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