Zeehan S. Husain, DPM
Charles G. Kissel, DPM
Michael S. Schey, DPM
Angela
Stoutenburg, DPM
Board
certified by the
American Board of
Podiatric Surgery.
Toe
Deformities
1.
Hammertoe
2.
Crossover
Toe
1. Hammertoe
Hammertoe is a contracture or bending of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Common symptoms of hammertoes include:
 |
Pain or irritation of the affected toe when wearing shoes. |
|
Corns (a buildup of skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location. |
|
Calluses (another type of skin buildup) on the bottom of the toe or on the ball of the foot. |
Corns and calluses can be painful and make it difficult to find a comfortable shoe. But even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with non-invasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Corns are more likely to develop as time goes on and corns never really go away, even after trimming. Corns are the symptoms and the hammertoe is the real problem that causes them to develop. In more severe cases of hammertoe, open sores may form.
Because
of the progressive nature of hammertoes, they should receive early
attention. Hammertoes never
get better without some kind of intervention.
What
Causes Hammertoe?
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.
Hammertoes
are often aggravated by shoes that do not fit properly such as shoes that
crowd the toes. And in some
cases, ill-fitting shoes can actually cause the contracture that defines
hammertoe. For example, a
hammertoe may develop if a toe is too long and is forced into a cramped
position when a tight shoe is worn.
Occasionally,
hammertoe is caused by some kind of trauma, such as a previously broken
toe. In some people,
hammertoes are inherited.
Non-Surgical
Treatments
There
are a variety of treatment options for hammertoe. The treatment your podiatric foot and ankle surgeon selects
will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
|
Trimming corns and calluses This should be done by a healthcare professional. Never attempt to do this yourself, because you run the risk of cuts and infection. Your podiatric surgeon knows the proper way to trim corns to bring you the greatest benefit. |
|
Padding corns and calluses Your podiatric surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your podiatric surgeon about this option. |
|
Changes in shoewear Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels. These conditions can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches. |
|
Orthotic devices A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance, but will not correct the hammertoe deformity after it has developed. |
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Injection therapy Corticosteroid injections are only used for severe acute pain and inflammation caused by hammertoe deformities. |
|
Medications Non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, are often prescribed to reduce pain and inflammation. |
|
Splinting/Strapping
Splints or small straps may be applied by the podiatric surgeon
to realign the bent toe. Again,
this is not corrective, but may be sufficient in holding the toe in
better position. |
When
Is Surgery Needed?
In
some cases, usually when the hammertoe has become more rigid, surgery is
needed to relieve the pain and discomfort caused by the deformity.
Your podiatric surgeon will discuss the options and select a plan
tailored to your needs. Among other concerns, he or she will take into consideration
the type of shoes you want to wear, the number of toes involved, your
activity level, your age, and the severity of the hammertoe.
The
most common surgical procedure performed to correct a hammertoe is called
an arthroplasty. In this
procedure, the surgeon removes a small section of the bone from the
affected joint.
The
preferred procedure for a hammertoe is an arthrodesis which involves
fusing a small joint in the toe to permanently straighten it. This makes it essentially impossible to have recurrence which
can occur with a simple arthroplasty.
A small screw is inserted into the toe to maintain alignment while
the bones heal. Patients are
able to ambulate immediately. Rarely
does the screw need to be removed. Sometimes
pins are used which are removed in the office around four to six weeks.
It
is possible that a patient may require other procedures especially when
the hammertoe condition is severe. Some
of these procedures include skin wedging (the removal of wedges of skin),
tendon/muscle rebalancing or lengthening, small tendon transfers, or
relocation of surrounding joints.
Often
patients with hammertoe have bunions or other foot deformities corrected
at the same time. The length
of the recovery period will vary, depending on the procedure or procedures
performed.
Crossover
toe is a condition in which the second toe drifts toward the big toe and
eventually crosses over and lies on top of the big toe.
Crossover toe is a common condition that can occur at any age,
although it is most often seen in adults.
Some people confuse crossover toe with a hammertoe, probably because both conditions involve a toe that does not lie in the normal position. However, crossover toe is entirely different from a hammertoe and much more complex.
Symptoms
of Crossover Toe
Although
the crossing over of the toe usually occurs over a period of time, it can
appear more quickly if caused by injury or overuse.
Symptoms may include:
|
Pain,
particularly on the ball of the foot.
It can feel like there is a marble in the shoe or a sock is
bunched up. |
|
Swelling
in the area of pain, including the base of the toe |
|
Difficulty
wearing shoes |
Crossover
toe is a progressive disorder. In
the very early stages, the best time to treat crossover toe, a patient may
have pain but no crossover of the toe.
Without treatment, the condition usually worsens to dislocation of
the joint, so it is very beneficial to have a foot and ankle surgeon
evaluate the foot soon after pain first occurs.
What
Causes Crossover Toe?
It
is generally believed that crossover toe is a result of abnormal foot
mechanics, where the ball of the foot beneath the second toe joint takes
an excessive amount of weight-bearing pressure.
This pressure eventually leads to weakening of the supportive
ligaments and a failure of the joint to stabilize the toe, resulting in
the toe crossing over.
Certain
conditions or characteristics can make a person prone to experiencing
excessive pressure on the ball of the foot.
These most commonly include a severe bunion deformity, a second toe
longer than the big toe, an arch that is structurally unstable, and a
tight calf muscle.
Diagnosis
Crossover
toe is sometimes misdiagnosed, especially in the early stages when there
is pain but the toe has not yet crossed over.
The pain experienced in crossover toe mimics a condition called
Mortons neuroma. The two
disorders, however, are treated very differently making it crucial to
obtain an accurate diagnosis. Treatment
with an inaccurate diagnosis will worsen the deformity and pain.
In
arriving at the proper diagnosis, the surgeons at the Rochester Center for
Foot and Ankle Surgery can differentiate the conditions and direct
appropriate treatment. The
surgeon will also look for potential causes and test the stability of the
joint. X-rays are usually
ordered, and other imaging studies are sometimes needed.
Non-Surgical
Treatments
The
best time to treat crossover toe is in the early stages, before the toe
starts to drift toward the big toe. At
that time, non-surgical approaches can be used to stabilize the joint,
reduce the symptoms, and address the underlying cause of the condition.
The
foot and ankle surgeon may select one or more of the following options for
early treatment of crossover toe:
Rest
and ice. Staying off the foot
and applying ice packs help reduce the swelling and pain.
Apply a bag of ice over a thin towel to the affected area for 20
minutes of each waking hour. Do
not put ice directly against the skin.
|
Oral
medications. Non-steroidal
anti-inflammatory drugs (NSAID), such as ibuprofen, may help relieve
the pain and inflammation. |
|
Immobilization.
Sometimes the foot is
immobilized for a while so that the injured tissue can heal. |
|
Taping/Splinting.
It may be necessary to tape
the toe so that it will stay in the correct position.
This helps relieve the pain and prevent further drifting of the
toe. |
|
Stretching.
Keeping the calf muscles
stretched is important in patients who have tight calf muscles. |
|
Shoe
modifications. Supportive
shoes with stiff soles are recommended because they control the motion
and lessen the amount of pressure on the ball of the foot. |
|
Orthotic
devices. Custom shoe
inserts are often very beneficial.
These include arch supports or a metatarsal pad that
distributes the weight away from the joint. |
When
Is Surgery Needed?
Once
the second toe starts moving toward the big toe, it will never go back to
its normal position unless surgery is performed.
The foot and ankle surgeon will select the procedure or combination
of procedures best suited to the individual patient.
