Hammer Toes
By: Corinne Gehegan, DPM
A toe is referred to as a hammer toe when it exhibits a flexed
(bent) position at one or more of the toe joints. It typically involves
the 2nd, 3rd, 4th, and 5th digits of the foot; however, the great toe
may also be involved. One or several toes may be hammered. Often times
the affected joint (knuckle) may appear red or inflamed. A
corn
(thickened skin) on top of the toe is often associated with hammer toes.
An individual may notice that the toe itself is painful as well as the
ball of the foot. Pain at the ball of the foot is due to the toe not
functioning or performing its job optimally. Therefore, excess pressure
develops at this area. Corns and calluses at the ball of the foot may be
a result of hammer toe deformity.
Hammer toes are often hereditary in nature. Poorly fitting shoes or
narrow/pointy shoe styles may accelerate or aggravate the condition. The
condition may evolve over time in regard to the flexibility of the
deformity. Initially, a hammer toe may be flexible. This means that it
can be manually straightened into a normal position. The deformity may
then become semi-flexible and finally rigid. Diagnosis is based on
examination. X-rays may be taken to assess the presence of arthritis and
other bone/joint abnormalities.
Hammer toes may be managed non-surgically and surgically. Non-surgical
modalities are often recommended prior to contemplating surgery. They
may include changing shoe styles or shoe sizes. Your foot should be
measured in the office and compared to your shoe size. The shoe size is
determined by the longest toe which is almost always the first toe or
the second toe. There are many commercially available products that
provide padding for the digits as well as the ball of the foot. Many
people find relief of discomfort with simply modifying shoe selection
and using these products. Caution is advised with over the counter “corn
remover” pads as they contain an acid that may worsen the inflammation.
Individuals with diabetes, poor circulation, or other conditions that
compromise healing should not use these medicated pads at all.
Surgical management involves multiple factors. The type of procedure and
the recuperation period are dependent on the patient’s age, activity
level, degree of deformity, and expectations. The goal of the surgery is
relief from pain and inflammation. The surgery usually involves cutting,
removal, and repositioning of skin, tendons, and bone to achieve a
balanced toe. Although toe surgery may seem like a simple matter, one
should be aware of all of the risks. Risks may include scarring,
infection, prolonged pain, prolonged swelling, stiffness, numbness,
shortened toe, elongated toe, overcorrection, and under correction.
Article written by Dr. Corinne Gehegan
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