What Is 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 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 nonsurgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
One of 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 may also be the result of deforming forces from a bunion or a long metatarsal bone.
Hammertoes may 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 shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
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 on their location.
Inflammation, redness or a burning sensation
Contracture of the toe
In more severe cases of hammertoe, open sores may form.
Although hammertoes are readily apparent, to arrive at a diagnosis, your Calgary podiatrist 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 do not 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.
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend on the severity of your hammertoe and other factors.
A number of nonsurgical measures can be undertaken:
Padding corns and calluses. Your Calgary 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 by either Dr Feldman or Dr Leavitt because they may contain a small amount of acid that can be harmful.
Changes in shoes. 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 toebox 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.
Tenotomy Procedure. Dr Leavitt has perfected a flexor tenotomy procedure that can be done in the clinic for painful hammertoes that are flexible. Book an appointment with Dr Leavitt for more information.
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, your Calgary podiatric 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.
As a general rule, Hammertoe Surgery procedures are performed on an out-patient basis in an Alberta Health Services (AHS) approved Surgical Center or in a Hospital. Surgical procedural costs are covered by AHS or the patient may opt for private surgery to avoid a waiting time. A visit to Feldman & Leavitt Foot And Ankle Specialists will CLEARLY define all available patient options.