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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