Hammertoe

WHAT YOU SHOULD KNOW

When one or more of the toes involuntarily curls into a hammer or claw-like position, the condition is called hammertoe. If the toe can be manually straightened out, the deformity is called a flexible hammertoe. If not, it's referred to as a rigid hammertoe.

Causes

The persistent curling that marks hammertoe is caused by the tightening of a tendon that connects a bone in the toe to a muscle in the foot. If the tendon routinely overpowers opposing tendons that straighten the toe, it will eventually shrink and hold the toe in a permanently bent position.

The problem is often the result of habitually wearing high heels. Shoes that are too tight to allow the toes to spread out may also be at fault. Pointed shoes and tight stockings can have the same effect. A number of diseases can also trigger the condition. Among them are diabetes, multiple sclerosis, arthritis, neuropathy (nerve damage), a herniated disc in the spine, and sciatica (pain in the legs and feet related to a damaged disk). In other cases, hammertoe is present at birth.

Signs/Symptoms

The toe typically affected by this disorder is the one next to the big toe. The condition may come on gradually and is usually painful. A corn, or area of thickened skin, may develop on top of the afflicted toe and rub against the shoe.

Care

Treatment for hammertoe requires holding the toe in its proper position with a strap and cushioning it from pressure until it regains its original position. Wearing sandals or wide, deep shoes gives the toe room to stretch out until the problem is resolved. If this approach doesn't work, surgery may be required to correct the problem. Potential measures include realigning the bone, cutting a tight tendon to release the toe, or removing a small portion of the toe bone under the corn. In some instances, the toe joint may be fused in a straightened position to stabilize the toe and prevent recurrence of the disorder.

Risks

Left untreated, this condition can lead to irreversible tendon damage and permanent deformity. Walking can become increasingly difficult.

WHAT YOU SHOULD DO

• Tape or strap the toe to adjacent toes in its normal position.
• Wear sandals or wide, deep shoes that give the toe plenty of room.
• Wrap a toe cap or padded sleeve around the toe to protect it from pressure or possible injury.
• You may take over-the-counter medications to relieve pain.
• If a callus or corn develops over the afflicted toe, trim it or cut it down using a pumice stone or a small pair of sharp scissors immediately after a bath or shower. You may also use an over-the-counter medication that contains keratolytic agents to dissolve the thickened skin.
• Stay off of your feet as much as possible until the problem is corrected.

Call Your Doctor If...

• You cannot manually move the afflicted toe back into place.
• You experience a lot of pain in the afflicted toe, or find it difficult to walk.
• Larger shoes and padding do not relieve the pain and discomfort.
• The toe becomes swollen.
• The toe becomes discolored.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• Anesthetic: A local or regional anesthetic is given to keep you from feeling any pain during the procedure.
• During the Hammertoe Repair Surgery...
  • You will lie on your back. The toe to be repaired will be cleaned.
  • The doctor will make a cut on the top of your toe and remove bone or cartilage as needed. An artificial replacement may be put in place if bone is removed.
  • A dressing and bandage will be applied to the toe.
  • Typically, you'll be able to go home the day of the surgery.

After You Leave

• Do not attempt to drive yourself home from the hospital. Stay off of your feet as much as possible for the next several days.
• Follow your doctor's instructions regarding dressing changes at the site of the operation. Keep the bandage clean and dry
• Take medications exactly as prescribed. Do not exceed the recommended dose.

Call Your Doctor If...

• You develop a fever.
• Blood continues to soak through the bandage.
• You notice redness, swelling, pus, a bad smell, or red streaks leading from the incision. These are signs of infection.

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