Treatment
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In children, mild hammer toe can be treated by manipulating and applying a splint in the affected toe. Changes in footwear such as the following tips may help relieve the symptoms:
- Wearing shoes that best fit the toe or opting to choose for shoes with wide toe boxes for comfort, and to avoid further progression of the hammer toe.
- Avoiding high heels as much as possible.
- Wearing insoles might help relieve pressure in the toe.
- Using corn pads or felt pads to protect sticking out joints.
A foot doctor (podiatrist) can make foot devices such as straighteners and hammer toe regulators as part of the treatment regimen. These could be bought as well.
Having an exercise regimen could help. Gentle stretching exercises can be done if the toe is not in a fixed position. Picking up a towel with the use of your toes can aid in stretching and straightening the foot’s smaller muscles.
For a severe hammer toe, an operation called osteotomy might be done to straighten back the joint.
- The surgery to be done might involve cutting and moving tendons and ligaments.
- Sometimes the bones on each joint are needed to be fused or connected to each other.
In most cases, this is an ambulatory surgery and the patient is allowed to go home on the day of the surgery. right after it. A feeling of stiffness may be present in the toe, yet it may go away in a shorter amount of time. If the underlying condition is treated early, surgery is oftentimes unnecessary. Necessary treatments are done to reduce pain threshold and eliminate walking discomforts. If hammer toe is suspected, an appointment with the physician regarding the best treatment options for pain and walking discomforts could also be done. For prevention purposes, shoes that are too short and narrow must not be worn. For children, regularly inspect foot growth if it coincides well with the current shoe size of the child.
The toes could still be moved at first. But over time, the person might find it hard to move his bigger toes, especially his middle toe.
Presence of Corn
A corn appears in the affected toe. It is caused by rapid cell growth in the toes that is caused by an occurrence where a healing blister leads the formation of a corn as the produced scar tissue is thicker than the normal skin. On the top, a solid corn may emerge and a distal corn at the hammer shaped side.
Callus Formation
A callus, or a thickened portion of the skin, appears on the sole part of the foot.
Pain
With the presence of corn and callus, when tight shoes are worn, it presents a painful experience, more so when walking around. Wearing poorly fitted footwear such as narrow, pointed toe shoes might predispose one to the symptoms, with pain as one of the late signs.
Nail Changes
The nail might split into two or may converge inwards.
Hammer Toes: Description
A Hammer Toe is marked by the contracture of the tendons, ligament laxity and angulations of the second and third phalanges of the toe. It composes of flexion deformities in the proximal interphalangal (PIP) joint of the toe, with a hyper extended metatarsophalangeal (MTP) and distal interphalangeal (DIP) joints. As one of the most painful toe disorders, hammertoe is traced from wearing pointed, narrow toe footwear. Women are more prone to hammertoes than men. Female shoes for most of the time have pointed front portions, and not much wide enough, thus making the foot look round. Hammertoe is created from a blend of factors such as narrow shoes and wider foot or pointed footwear and a rounded foot.
Compression of the feet and constriction of the toes depends on the shoes being used. These may eventually lead to muscle wasting, and decreased motions in the toes. And the result is the toes may have little room to operate. In an ill-fitting shoe, the toe seeks room anywhere it can be found. The pressure is increased, thus leading to the hammer-like shape of the toe.
Due to continuous PIP joint flexion deformity, the occurrence of MTP and DIP compensatory hyperextension might occur. The hyperextension of the MTP joint and the flexion of the PIP joint make the PIP joint move dorsally. This prominence is rubbed against the patient’s shoe, thus the pain is felt. The deformity is flexible and could be passively corrected early but eventually could be corrected as time goes by. Progressive deformities may eventually lead to dislocated joints.
Causes
Most causes of hammer toes come from the person’s selection of shoes, yet other factors also play a role in its formation.
Footgear
The choice of foot gears, not only just shoes but also ill-fitting stockings, tapered toe shoes, pointed toe shoes, tight leotards and snugly pantyhose could all lead to a painful hammertoe. There could even be a possibility of getting hammertoes foot in both feet, since basically these things are worn in both extremities. It might also lead to nerve and joint damage.
Genetic Factors
Some people might be born with a hereditary contracture, but the only thing that increases the risk of familial tendencies is wearing ill-fitting shoes, even though an individual is predisposed to such as a systemic disease like arthritis.
Diagnosis
Usually, a physical examination is done to confirm the presence of hammer toes. The health care provider, such as a physician might find decreased and painful movement of the toes. The patient is asked with the following questions as part of the initial assessment:
- A presence of fever or localized erythema. An erythema might suggest phlebitis, gout, osteomyelitis, cellulitis, ingrown toenail and paronychia. Fever may present signs of infection such as osteomyelitis and cellulitis.
- If there is an associative foot deformity. Aside from hammertoe, hallux vagus, hallux rigidus, arthritis and displaced fractures are other foot deformities also assessed.
- The presence of palpable peripheral pulses. Diminishing arterial pulses would be a conclusion of arterial embolism, peripheral arteriosclerosis and diabetes.
- An associated neurological finding. The presence or loss of sensation of touch and pain should make one a possibility for peripheral neuropathy or carpal tunnel syndrome. Morton’s Neuroma is also associated with numbness or loss of sensation in the 3rd and 4th toes.
Diagnostic Tests
A series of routine tests are done, including a CBC, sedimentation rate, chemistry panel, VDRL tests and X-Rays of the foot. If there are diminishing peripheral pulses, Doppler tests and angiography are measured. Venography is done if there is a presence of diffuse swelling and erythema. Bone and CT scans as well as arthroscopy are considered if results are found out to be negative. To diagnose stress fractures, a MRI may be needed. With the use of quantitative scintigraphs, abnormal weight distribution in the toes may be diagnosed.
Treatment
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In children, mild hammer toe can be treated by manipulating and applying a splint in the affected toe. Changes in footwear such as the following tips may help relieve the symptoms:
- Wearing shoes that best fit the toe or opting to choose for shoes with wide toe boxes for comfort, and to avoid further progression of the hammer toe.
- Avoiding high heels as much as possible.
- Wearing insoles might help relieve pressure in the toe.
- Using corn pads or felt pads to protect sticking out joints.
A foot doctor (podiatrist) can make foot devices such as straighteners and hammer toe regulators as part of the treatment regimen. These could be bought as well.
Having an exercise regimen could help. Gentle stretching exercises can be done if t
he toe is not in a fixed position. Picking up a towel with the use of your toes can aid in stretching and straightening the foot’s smaller muscles.
For a severe hammer toe, an operation called osteotomy might be done to straighten back the joint.
- The surgery to be done might involve cutting and moving tendons and ligaments.
- Sometimes the bones on each joint are needed to be fused or connected to each other.
In most cases, this is an ambulatory surgery and the patient is allowed to go home on the day of the surgery. right after it. A feeling of stiffness may be present in the toe, yet it may go away in a shorter amount of time. If the underlying condition is treated early, surgery is oftentimes unnecessary. Necessary treatments are done to reduce pain threshold and eliminate walking discomforts. If hammer toe is suspected, an appointment with the physician regarding the best treatment options for pain and walking discomforts could also be done. For prevention purposes, shoes that are too short and narrow must not be worn. For children, regularly inspect foot growth if it coincides well with the current shoe size of the child.
