Uneven muscle hammertoes
tension results in the distortion
of one or several of the small toes. (Hammer toes
) Pressure points develop at the raised middle joint as well as at the tip of the toe
and underneath the metatarsal head. In the beginning, when the misalignment can still be corrected, it often suffices to lengthen the tendon and to cut a notch into the capsule
. In a contracted misalignment, part of the middle joint is removed to form a replacement joint. Modern surgical techniques preserve the metatarsophalangeal joint (Weil or Helal osteotomies).
Hammertoes are most common in women, and a big part of this is poor shoe choices, which are a big factor in the development of many foot problems. Tight toe
boxes and high heels are the biggest culprits. Genetics certainly plays a role in some cases of hammertoes, as does trauma, infection, arthritis, and certain neurological and muscle disorders. But most cases of contracted toes are associated with various biomechanical abnormalities in how a patient walks. This causes the muscles and tendons to be used excessively or improperly, which deforms the toes over time.
The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe
may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe
or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.
Most health care professionals can diagnose hammertoe simply by examining your toes and feet. X-rays of the feet are not needed to diagnose hammertoe, but they may be useful to look for signs of some types of arthritis (such as rheumatoid arthritis) or other disorders that can cause hammertoe. If the deformed toe
is very painful, your doctor may recommend that you have a fluid sample withdrawn from the joint with a needle so the fluid can be checked for signs of infection or gout (arthritis from crystal deposits).
Non Surgical Treatment
If the affected toe
is still flexible, you may be able to treat it by taping or splinting the toe
to hold it straight. Your family doctor can show you how to do this. You may also try corrective footwear, corn pads and other devices to reduce pain. You may need to do certain exercises to keep your toe
joints flexible. For example, you may need to move and stretch your toe
gently with your hands. You can also exercise by picking things up with your toes. Small or soft objects, such as marbles or towels, work best. If your hammer toe
becomes painful, you may need to apply an ice pack several times a day. This can help relieve the soreness and swelling. Nonsteroidal anti-inflammatory medicines (also called NSAIDs), such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve), may be helpful. If your pain and swelling are severe, your doctor may need to give you a steroid injection in the toe
If these non-invasive treatments don?t work, or if the joint is rigid, a doctor?s only recourse may be to perform surgery. During the surgery, the doctor makes an incision and cuts the tendon to release it or moves the tendon away from or around the joint. Sometimes part of the joint needs to be removed or the joint needs to be fused. Each surgery is different in terms of what is needed to treat the hammertoe. Normally after any foot surgery, patients use a surgical shoe for four to six weeks, but often the recovery from hammertoe surgery is more rapid than that. An unfortunate reality is that hammertoe can actually return even after surgery if a patient continues to make choices that will aggravate the situation. Though doctors usually explain pretty clearly what needs to be done to avoid this.