Is Hammer Toe Surgery Effective

Overview

The term, hammertoe is used to describe the collective physical deformity of the second, third and fourth toe on a person's foot when they are permanently bent at one or two of their joints, often times at their middle joints or, 'proximal interphalangeal,' joints. The condition is also referred to as, 'contracted toes,' and earned its name for the resulting bowed appearance of the toes that made them appear similar to hammers. The distortion of the usual contour of the person's toes is usually a result of wearing shoes that are too short or narrow and apply consistent pressure Hammer toes to the toes, forcing them to be pushed together and lie obliquely. The situation is particularly true in the case of shoes that are designed to narrow towards the toe box.

Causes

A hammer toe develops because of an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.

Symptoms

At first, a hammertoe or mallet toe may maintain its flexibility and lie flat when you're not wearing crowded footwear. But eventually, the tendons of the toe may contract and tighten, causing your toe to become permanently stiff. Your shoes can rub against the raised portion of the toe or toes, causing painful corns or calluses.

Diagnosis

A hammertoe is usually diagnosed with a physical inspection of your toe. Imaging tests, such as X-rays, may be ordered if you have had a bone, muscle, or ligament injury in your toe.

Non Surgical Treatment

Pad it. Mild cases of hammertoe can be treated with corn pads or felt pads available in the pharmacy. Toe caps, the small, padded sleeves that fit around the tip of the toe, may relieve hammer toe pain. Change your shoes. Wear wide shoes with resilient soles. Avoid shoes with pointed toes. Exercise. Certain exercises such as moving and stretching your toe gently with your hands and picking small or soft objects such as marbles or towels can keep your toe joints flexible. Also, while you are watching television or reading, you can also put a towel flat under your feet and use your toes to crumple it. This simple exercise can stretch and strengthen your muscles. Use ice. If your hammer toe becomes painful, applying an ice pack several times a day can help relieve the soreness and swelling.

Take medications. Nonsteroidal anti-inflammatory medicines (also called NSAIDs), such as ibuprofen or naproxen may be helpful in minimizing pain and inflammation. Use orthotic devices. Place a custom orthotic device in your shoe. This will help control the muscle/tendon imbalance.

Surgical Treatment

Sometimes, if the deformity is severe enough or surgical modification is needed, the toe bones may be fused so that the toe does not bend. Buried wires are used to allow for the fusion to heal, and they remain in place after healing. Your skin is closed with fine sutures, which are typically removed seven to ten days after surgery. A dressing is used to help keep your toes in their new position. Dressings should not get wet or be removed. After surgery, your doctor may prescribe pain relievers, typically for the initial four to seven days. Most people heal completely within one month of surgery, with few complications, if any. Crutches or a cane may be needed to help you keep weight off your affected foot, depending on the procedure. Occasionally, patients receive a special post-op shoe or a walking boot that is to be worn during the healing process. Most people are able to shower normally after surgery, but must protect the dressing from getting wet. Many patients are allowed to resume driving within one week after the procedure, but care needs to be taken.

Prevention

Daily modifications and correct shoe choices can prevent and slow the progression of hammertoe deformities. The main cause in hammertoe deformities is muscle/tendon dysfunction. Wearing of ill-fitting, tight, high heeled shoes contributes to the progression to hammertoe deformities. Also, bunion conditions can enhance the formation of hammertoes. A key to prevention of hammertoes is the wearing of correct footwear, specifically shoes with appropriate support and a deep, wide toe box.