Hammer Toes
Definition
A foot digit permanently flexed at the proximal phalangeal joint and hyperextended at the distal interphalangeal joint, producing a clawlike appearance. The anomaly may be present in more than one digit but is most common in the second toe. It may accompany clawfoot.
Causes
The causes can be multifactorial. Basically, anything which can upset the delicate balance of tendons and muscles which keep the toes on the ground can create hammertoes. Think of a marionette (string puppet), where pulling different strings will cause the puppet to move in different directions. Your toes are very similiar, where the strings are the tendons located in your foot and leg, all working together. If you have overpowering of one tendon or group of tendons, the toes will no longer be balanced and the joints will bend in a hammertoe position.
The most frequent cause of hammer toe is a muscular and/or tendinous imbalance. This imbalance is due to mechanical (structural) changes in the foot. Non-surgical solutions can relieve pain but will not directly treat the cause of deformity.
Hammer toes
often get worse due to unsuitable footware, for example shoes that squash the toes. In certain cases, ill-fitting shoes can be the cause of the joint deformity responsible for the onset of hammer toes. For example, a hammer toe can develop if the toe is too long and is bent in a shoe that is too narrow.
Treatment and Prevention
Non-Surgical Treatment of Hammertoes includes:
Padding corns and calluses: Your podiatrist can either prescribe or provide you with a special pad designed to shield corns and prevent irritation.
Changes in shoewear: Shoes with pointed toes are strictly forbidden. The same goes for shoes that are too short or high heels. All three of these will force the toe against the front of the shoe, aggravating your condition.
Orthotic devices: Custom orthotics can be placed in your shoe to help control the muscle/tendon imbalance.
Injection therapy: Corticosteroid injections can be used to ease pain and inflammation.
Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Splinting/strapping: Splints or straps may realign the affected toe. If the hammertoe does not get better with non-surgical treatment and your condition worsens, surgery may be your last option.
Surgery is sometimes required for this condition. The surgeon, employing minimal-incision techniques uses a power-driven tool to file away a small wedge of bone from the angle of the contracture. This is a painless procedure done under a local anesthetic and the patient is able to walk home. A few days of recuperation is, however, necessary. The toe is held in its corrected position by a small splint until fusion of the bone takes place, usually within a few weeks.
In an alternative minimal-incision procedure, a surgeon can lengthen the tendon. Eliminating the contracture of the tendons on the top of the foot strengthens the movement of the hammertoe so it can uncurl and straighten.
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