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Hammer Toe

Hammertoe is a contraction deformity that usually occurs in the lesser toes resulting from imbalance of the tension forces in the tendons attachment. The hammertoe deformity can put pressure on the toe when wearing shoes, causing pain and skin irritation.

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Hammertoes deformities are a progressive deformity that can worsen over time. In the early stages of the deformity, hammertoes are flexible and the deformity can be reduced with less invasive methods. However, if left untreated, hammertoes can become more rigid and causes damage to the small joint of the toes that does not respond to nonsurgical treatment.

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The most common cause of hammertoe is imbalance of the pulling muscle tendons across the toes causing the toes to bend. This imbalance might be caused by mechanical or neurological changes in the foot.

Ill-fitting shoes can exacerbate hammertoes. In some cases, hammertoe is the result of an earlier trauma to the toe or to the tendon. In some people, hammertoe deformities are genetic that run in the family.

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  • Pain or irritation of the affected toe from rubbing against the shoes.

  • Corns and calluses on the toe, between two toes or on the ball of the foot. Corns are caused by constant friction of the skin against the shoe. 

  • Inflammation, redness or a burning sensation.

  • Contracture of the toe.

  • In more severe cases of hammertoe, skin ulceration may occur.

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Your doctor will obtain history of the symptoms and perform foot examination. During the physical examination, your doctor may reproduce your symptoms by manipulating your foot and will study the flexibility of the contractures. In addition, your doctor may take x-rays to determine the degree of the deformities and assess any bone changes that may have occurred.

Hammertoes are progressive in nature and can get worse over time. However, not all cases are alike. A treatment plan can be developed based on the extent of the deformity.

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There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend on the severity of your hammertoe and other factors.

A number of nonsurgical measures can be undertaken:

  • Padding for corns and calluses. This helps prevent the skin irritation that may result from the shoes rubbing against the deformed toes and may help alleviate the pain.

  • Footwear. Avoid narrow pointed shoes, short shoes, or high heel shoes that might worsen the hammertoe conditions by forcing the toe against the front of the shoe. Comfortable shoes with a deep, roomy toe box and low heel are advised.

  • Splinting/strapping. Hammertoe splints or small straps may be applied to realign the contracted toe.

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Surgical Treatment

Surgery is indicated if hammertoe became rigid, causing continues pain or corn, or breaking down the skin to ulcers. Surgical planning is dependent on the extent of the deformity. In some cases the hammertoe deformity is flexible and can be managed with less invasive percutaneous intervention to release the contracted tendon. However, in more advanced cases, the toe joints are arthritic and can't be reduced to which a surgical intervention that involve cutting through the bones to straighten the toe might be considered.

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