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Foot Pain

Foot Troubles Database

Hammer Toe Operation Difficulties

HammertoeOverview

Uneven muscle tension results in the distortion of one or several of the small toes. (hammertoes) 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).

Causes

Most hammertoes are caused by wearing ill-fitting, tight or high-heeled shoes over a long period of time. Shoes that don't fit well can crowd the toes, putting pressure on the middle toes and causing them to curl downward. The condition may be more likely when the second toe is longer than the first toe or when the arch of the foot is flat. Hammertoe can also be present at birth (congenital). Hammertoe also can be caused by a bunion, which is the knobby bump that sometimes develops at the side of the big toe. A bunion causes the big toe to bend toward the other toes. The big toe can then overlap and crowd the smaller toes. Occasionally, a hammertoe is inherited or caused by arthritis in the toe joint.

Hammer ToeSymptoms

Symptoms include sharp pain in the middle of the toe and difficulty straightening the toe. People with hammertoe may also develop blisters, which are fluid-filled pockets of skin, because the bent toe is likely to rub against the inside of a shoe. This increased friction may also lead to calluses, which are areas of thickened skin, and corns, which are hard lumps that may form on or between toes. Symptoms may be minor at first, but they can worsen over time.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon 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.

Non Surgical Treatment

Treatment for a hammertoe usually depends on the stage of the hammertoe and the cause of the condition. If your toe is still bendable, your doctor may suggest conservative care-relieving pressure with padding and strapping, or proper shoes that have a deep toe box and are of adequate length and width. Early intervention can often prevent the need for surgery.

Surgical Treatment

Surgery to straighten the toe may be needed if an ulcer has formed on either the end or the top surface of the toe. Surgery sometimes involves cutting the tendons that support movement in the toe so that the toe can be straightened. Cutting the tendons, however, takes away the ability to bend the very end of the toe. Another type of surgery combines temporary insertion of a pin or rod into Hammer toe the toe and alteration or repair of the tendons, so that the toe is straightened. After surgery, the deformity rarely recurs.

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