A hammertoe is a foot condition in which the toe has an abnormal bend in one or both joints. There are hereditary components to why hammertoes form, but they also can be made worse over time by ill fitting shoes and activity. This is a progressive condition in which the toe becomes stiff over time and painful corns can form. There are conservative and surgical treatments for hammertoes. Your doctor may recommend conservative treatments at first and if these treatments fail, or in more severe cases, then surgery may be considered.
Prevention with proper shoe gear is probably the best advice any doctor can give their patient with regards to hammertoes. Choose shoes with a low heel roughly two inches or less. Higher heeled shoes force the toes into unnatural positions that can cause the toe to become bent and lead to a hammertoe. Make sure as well there is adequate room in the toe box so that the toe can bend freely. Conservative treatments largely include refraining from shoes that are tight and with a narrow toe box. Proper fitting and shoes with a soft upper can make your hammertoe feel more comfortable. Podiatrists can also create a shoe insert or orthotic to stop the hammertoe from worsening.
There are many over the counter products available like corn cushions and corn pads, which can also help, alleviate discomfort. Podiatrists will, however, often discourage patients from using medicated corn plasters or pads. Patients that become overzealous with usage of these products and this can lead to skin irritations and sores that may develop into secondary infections. Consult your podiatrist before using these types of products. The corns are usually associated with hammertoes and a podiatrist, who can provide immediate relief, can shave much of this dead skin down. There also occasions where the doctor can inject cortisone into the toe corn to help relieve the pain and inflammation as well.
Gently stretching your toes manually several times a day can also help alleviate pain and reposition the affected toe. Over the counter toe spacers are also a popular way to keep the ligaments, tendons and bones of the toes as flexible as possible.
When shoe gear changes, pads, orthotics and stretching do not alleviate the symptoms of hammertoes surgery is often recommended. However, not all hammertoes are treated alike surgically. Depending on how rigid or flexible the hammertoe is can dictate which procedure to do. In addition to clinical exam, X-rays are routinely performed to help evaluate which stage the toe is in. If the hammertoe is relatively flexible, soft tissue procedures may be implemented to help correct the hammertoe. These procedures are called tenotomies and tendon transfers. A tenotomy is a relatively simple procedure which is a minimally invasive. A small incision is made at the base of the involved toe and the tendon is cut releasing the contracture. Sometimes the tendon from under the toe is rerouted or transferred to the top of toe to help straighten the toe.
When the toe joints are less flexible an arthroplasty is usually indicated. Most hammertoe procedures performed today are arthroplasties. An arthroplasty requires removing a small portion of the bone underlying the corn or knuckle. This procedure is fairly simple and can be performed on an outpatient basis in a hospital or surgery center. There are approximately 4-5 stitches that are needed to close the wound and there is a compression bandage that is applied over the toe to maintains the toe’s new position. The dressing is changed weekly and a surgical shoe is used to ensure healing and to protect the toe. After approximately 3 weeks the patient can go into a flexible shoe and then gradually get into regular shoe gear. Physical therapy may be implemented post operatively.
An arthrodesis is another common procedure performed on more rigid hammertoes. After removing small bony portions of the toe joint, the toe is fused in a straight position with the help of a pin. This pin can be removable or permanently buried in the bone. These implants can be absorbable or metal. This procedure may have a slightly longer recovery time than an arthroplasty.