Hammertoe Surgery Treatment

Hammer ToeOverview

Hammer toes is a secondary problem originating from fallen cross arches. The toes start to curl and get pulled backwards, as the collapsed or pushed out metatarsal bones pull the tendons and ligaments, and causes them to get shorter and tighter. This condition causes the toes have higher pressure and they have limited movement and cannot be straightened fully. This can lead to numbness and pain in the toes as muscles, nerves, joints and little ligaments are involved with this condition. As the top part of the toe can rub against the shoe, it can cause corns and calluses.

Causes

If a foot is flat (pes planus, pronated), the flexor muscles on the bottom of the foot can overpower the others because a flatfoot is longer than a foot with a normal arch. When the foot flattens and lengthens, greater than normal tension is exerted on the flexor muscles in the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe. If a foot has a high arch (pes cavus, supinated), the extensor muscles on the top of the foot can overpower the muscles on the bottom of the foot because the high arch weakens the flexor muscles. This allows the extensor muscles to exert greater than normal tension on the toes. The toes are not strong enough to resist this tension and they may be overpowered, resulting in a contracture of the toe, or a bending down of the toe at the first toe joint (the proximal interphalangeal joint) which results in a hammertoe.

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

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

Many people start by treating the problem themselves when they have a painful corn or callus. They try to remove the corn by cutting it off or by applying strong acids, and they try to cushion the toe by applying cushioned pads. Because these treatments can be difficult to perform by oneself (and should never be done by oneself when the patient is diabetic or circulation is poor), and because these treatments only treat the symptom, not the structural deformity that causes their symptom, these treatments can often provide only limited success, and often any success is for only short periods of time. Changes in shoe choices and various types of paddings and other appliances may help, too. For longer-lasting help, we must examine the cause of the deformity. The reason for knowing the cause is that the type of treatment will vary, depending upon the cause of the complaint. Orthotics help control the causes of certain types of contracted toes, (those caused by flexor stabilization, for example), but not other types.

Surgical Treatment

If a person's toes have become very inflexible and unresponsive to non-invasive means of treatment and if open sores have developed as a result of constant friction, they may receive orthopaedic surgery to correct the deformity. The operation is quick and is commonly performed as an out-patient procedure. The doctor administers a local anesthetic into the person's foot to numb the site of the operation. The person may remain conscious as the surgeon performs the procedure. A sedative might also be administered to help calm the person if they hammertoe are too anxious.

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