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hammertoe is a contracture of the toe as a result of a muscle imbalance
between the tendons on the top and the tendons on the bottom of
the toe. Hammertoes 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 the shoe. They may also cause
a painful callus 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 callus 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 a 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 straighten out and correct themselves over time. 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 and medicated corn pads to temporarily reduce the painful
callus often seen with a hammertoe. These medications must be used
with caution. They are a mild acid that burns off the callus. These
medications should never be used for corns between the toes. Persons
with diabetes or poor 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 than a single stitch. Of course if several toes are
done at the same time, the recovery may 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/or
the surgeon may elect to fuse the bones in the toe. This requires
several weeks of recovery.
Complications associated with the surgery include infection, excessive
swelling, and 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 performed in the doctor's office under
local anesthesia. Many patients prefer the comfort of sedation during
surgery, in an outpatient surgery center.
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