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Common Foot
Conditions
Hammertoe
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. (Corns and Calluses)
They tend to slowly get worse with time and frequently
flexible deformities become rigid. Treatment can be
preventative, symptomatic or curative. (For information
on hammertoe of the big toe see Hallux hammertoe)
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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