HAMMERTOES

SYMPTOMS

Hammertoe is the general term used to describe an abnormal contraction or "buckling" of the toe because of a partial or complete dislocation of one of the joints of the toe or the joint where the toe joins with the rest of the foot. As the toe becomes deformed, it rubs against the shoe and the irritation causes the body to build up more and thicker skin to help protect the area. The common name for the thicker skin is a corn. At first, this thick skin helps reduce irritation to the bone prominence, but as the skin becomes thicker, it adds to the pressure from the shoe. Periodic trimming of the corn may give temporary relief. However, over a period of time, a bursa may develop and if it becomes inflamed (bursitis), the area becomes red, swollen and painful. It may also become infected.

There are two joints in the lesser toes and one joint in the great toe. If the deformity occurs in the joint nearest the nail, it is called a mallet toe and the corn will usually develop on the tip of the toe. This is due to the pressure being on the tip of the last toe bone rather than at the fat pad under the tip of the toe. If the deformity is at the other toe joint, or where the toe joins the foot, it is called a hammertoe and the corn will occur on the top of the toe. Corns may also develop between toes. These are usually due to a rotation of the toe, rather than a contraction (buckling). This can cause the joints to rub together and may create small bone spurs that cause corns in a similar manner. Do not confuse corns with calluses that occur on the bottom of the feet. They are generally caused by other conditions, although a severe hammertoe may create downward pressure on a metatarsal bone at the ball of the foot, and add to the cause of a callus.

CAUSES

Although there is little doubt shoes are responsible for causing corns, the size, shape and other characteristics of our feet are hereditary. The contraction and/or rotation of toes can be the result of poor mechanics of the foot, resulting in over-pronation. This results in low or flat arches, which cause the muscles and tendons of the foot to twist the toes and joints away from their normal position. High arched feet can also result in similar conditions. A severe bunion may cause a hammertoe, as the great toe twists over or under the second toe, causing it to dislocate. Shoes cause the corn, as the bony top of the toe rubs on the toe box of the shoe, but the underlying problem is the abnormal position of the toe joints, which may be hereditary. The crooked toe is irritated by shoe pressure on the joint or spur. As a result, the skin becomes thicker to form a protection. The thicker the skin, the more pressure and eventually, a bursitis under the corn may develop. This causes the joint to become red, swollen and painful. Additionally, the skin can break down and become infected.

TREATMENT

The most important thing is to purchase well fitted, comfortable, low heeled shoes that do not irritate the crooked toe. Also, make sure your stockings are not tight, causing the toes to contract. High heel shoes should be worn at a minimum, as they cause the tendons of the toes to pull them up into an contracted position. Tennis type and walking shoes have significantly decreased the complaint of many people with hammertoe deformities. Although the crooked toe is still present, it may not hurt if the shoe is large enough. BATH TUB SURGERY IS NOT A GOOD IDEA! Trimming corns with a razor blade may give temporary relief, but is dangerous, as you can cut yourself and cause an infection. Non-medicated pads from the drug store do give relieve from shoe pressure and are helpful. However, if the toe becomes red and swollen, consult with your family podiatrist right away. Treatment may range from more appropriate footgear to periodic trimming and padding of the corn. Cortisone injections may be indicated if a bursitis is present. Removable accommodative pads may be made for you. If conservative treatment is unsuccessful, surgical intervention may be suggested. In the early stages, when the toe joints are flexible. If the toe is relatively straight and the corn is caused by pressure on a spur, the enlarged bone may be remodeled and the spur removed. In more advanced cases, when the joint is dislocated, part of the bone at the joint may be removed. Most of these toe surgeries can be performed in the office or the outpatient surgery under local anesthesia. Sometimes you can wear sandals after surgery and other times, a special stiff soled shoe is used so you can walk right away.