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Hammertoe

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Robert J. Snyder, MD
Foot problems are common orthopaedic issues we see daily at OSC, like the foot deformity condition called Hammertoe. In this article, I will describe it and how the condition is treated.
When the second, third or fourth toe becomes abnormally bent at the middle joint, it is called Hammertoe, because it resembles a hammer. The toe is typically painful when walking, running or wearing footwear.  The toe may become difficult to move.  A callus, blister or corn may form at the point where the toe is abnormally bent, because it rubs on footwear. If not treated, an ulcer can form at the site of the corn or callus and become infected. The toe can become permanently bent, requiring surgery to straighten.
Hammertoe is caused by poorly fitting shoes or boots, injuries to the toes, diabetic neuropathy, other nerve conditions or heredity.   You are also more prone to Hammertoe if your second toe is longer than your big toe. Hammertoe happens more often to women than to men and the risk increases with age.  Diagnosing Hammertoe is done by taking x-rays, examining the toe and talking to the patient about their symptoms.
Hammertoe is treated conservatively with shoe inserts, orthotics, shoe pads and padded socks which provide support, cushioning.  Wearing shoes with enough toe room and low heels are a must. Exercises for the toe can help restore some toe movement. Surgery will be necessary if conservative treatment doesn’t work.
Hammertoe surgery is done on an outpatient basis and involves releasing or realigning a tendon that has constricted to bend the toe.  Sometimes, it is also necessary to remove a piece of bone and/or shorten the toe for it to straighten fully.  Surgical pins may be inserted in the bone to hold the toe in place while it heals.  These will be removed after a month of recovery.
The severity of your hammertoe and the surgery required to repair it will predicate the length of your recovery.  Most patients will wear a hard shoe for walking on the operated foot.  Some may use crutches or a walker.  It will be important to keep your operated foot elevated during the first weeks of recovery.  It is important not to submerge your foot in water while it has pins in it. Driving will be out of the question for a few weeks if your right foot was affected.  Many folks find that they can return to most activities and driving after about six weeks, although post-operative swelling can continue for up to a year.
It is easier to prevent Hammertoe than to correct it.  Wearing shoes with plenty of room in the toe box is important for averting this condition. Ditch those pointy-toed stiletto heels and buy some low heeled pumps.
Do toe exercises.  I know most of you will laugh when I say that, but hear me out. Imagine sitting in a chair on the beach.  Most of us move the sand back and forth with our feet as we sit watching the waves, so think of how you flex and bend your toes when playing in the sand, and you will get the picture.  Do you remember walking or standing in the water and feeling a seashell underfoot, which you then tried picking up using only your toes?  Just like that, try picking up a marble, ink pen or towel using only your toes.  Do these exercises regularly.
If one or both parents suffered from Hammertoe(s), it is important to be vigilant about your own toes. Seek treatment if you notice one of your toes starting to hurt or bend abnormally.  If it is addressed quickly, Hammertoe does not have to end with surgery, but can be held at bay with conservative treatments.

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