The term, Hammertoe is used to describe the collective physical deformity of the second, third and fourth toe on a person's foot when they are permanently bent at one or two of their joints, often times at their middle joints or, 'proximal interphalangeal,' joints. The condition is also referred to as, 'contracted toes,' and earned its name for the resulting bowed appearance of the toes that made them appear similar to hammers. The distortion of the usual contour of the person's toes is usually a result of wearing shoes that are too short or narrow and apply consistent pressure to the toes, forcing them to be pushed together and lie obliquely. The situation is particularly true in the case of shoes that are designed to narrow towards the toe box.
The main cause of hammer toe is poorly fitted and/or poorly designed footwear. Any footwear that is too tight in the toe box, especially high-heeled shoes, can push the toes forward, crowding one or more of them into a space that is not large enough to allow the toes to lie flat and spread as they should. Other causes include the following. Changes in foot anatomy. Sometimes the metatarsal bones in the ball of the foot can ?drop,? creating a situation in which the toes do not make contact with the surface of the shoe. The toes may then contract at one or both of the joints to re-establish contact with the surface. Traumatic injuries in which toes are jammed or broken. Diabetic neuropathy. This can cause abnormal foot biomechanics due to nerve and/or muscle damage. Damage to nerves and muscles from other conditions, such as arthritis or stroke. Heredity.
Pain upon pressure at the top of the bent toe from footwear. The formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.
Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.
Non Surgical Treatment
In many cases, conservative treatment consisting of physical therapy and new shoes with soft, spacious toe boxes is enough to resolve the condition, while in more severe or longstanding cases podiatric surgery may be necessary to correct the deformity. The patient's doctor may also prescribe some toe exercises that can be done at home to stretch and strengthen the muscles. For example, the individual can gently stretch the toes manually, or use the toes to pick things up off the floor. While watching television or reading, one can put a towel flat under the feet and use the toes to crumple it. The doctor can also prescribe a brace that pushes down on the toes to force them to stretch out their muscles.
Sometimes when the joints are removed the two bones become one as they are fused in a straightened position. Many times one toe will be longer than another and a piece of bone is removed to bring the toes in a more normal length in relation to each other. Sometimes tendons will be lengthened, or soft tissue around the joints will be cut or rebalanced to fix the deformity. Angular corrections may also be needed. The surgeon may place fixation in your foot as it heals which may include a pin, or wires.
Have your feet properly measured, make sure that, while standing, there is a centimetre (? thumb) of space for your longest toe at the end of each shoe. Buy shoes that fit the longer foot. Shop at the end of the day, when foot swelling is greatest. Don't go by numbers, sizes vary by brand, so make certain your shoes are comfortable. Wear wide shoes with resilient soles, avoid shoes with pointed toes.
Hallux valgus, often referred to as "a bunion," is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. (A bony lump on the top of the big toe joint is usually due to a different condition, called hallux rigidus.) Sometimes a soft fluid swelling develops over the bony lump. The bony lump is the end of the "knuckle-bone" of the big toe (the first metatarsal bone) which becomes exposed as the toe tilts out of place.
You may get bunions if the way your foot is shaped puts too much pressure on your big toe joint. Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people more likely to get them. Your foot rolls inward too much when you walk. A moderate amount of inward roll, or pronation, is normal. But damage and injury can happen with too much pronation. You have flat feet. You often wear shoes that are too tight. All of these may put pressure on the big toe joint. Over time, the constant pressure forces the big toe out of alignment, bending it toward the other toes.
With an advanced bunion, the big toe joint can be significantly deformed. The big toe can crowd the other toes and may lie over or under the second toe. The larger the bunion gets, the more it hurts to walk. Wearing any type of shoe can be painful. Symptoms of bunions tend to increase over time as the condition worsens. Typical symptoms include deformity of the big toe joint. Growth of a bony lump (exostosis) at the side of the big toe joint. Pain, redness and tissue swelling (bursitis) over the big toe joint, with thickening of overlying skin. Pain when walking (particularly during the "push off" phase). Overlapping of the big toe above or below the second toe in severe cases.
Your doctor is very likely to be able to diagnose your bunion simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate the types of shoes you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to determine the extent of your deformity.
Non Surgical Treatment
Most of the time, non-surgical (conservative) treatment can control the symptoms of a foot bunion or bunionette. These include. Appropriate Footwear, changing to wide fitting footwear reduces the pressure on the big toe and prevents shoes from rubbing on the bony lump. When possible, go barefoot Toe stretchers are a really simple way to reduce foot bunion pain. Toe Stretchers, wearing toe spaces that fit in-between the toes help to stretch the muscles and ligaments around the toes, improving the alignment and relieving pain. Find out more about how these work in the Toe Stretcher section. Painkillers, your doctor may prescribe or recommend over-the-counter medication to reduce the pain and inflammation. Foot bunion correctors can be worn in your shoe to help realign your foot if you suffer from foot bunions. Orthotics. There are a number of over-the-counter shoe inserts that can help relieve symptoms. Bunion correctors work by realigning the bones in your foot to reduce pressure on the affected toe. There are both day-time and night-time splints on the market, although the evidence of their effectiveness is lacking. Ice. Applying ice packs to the foot can help reduce pain and inflammation. Bunion pads help to reduce any friction on your big toe. Bunion Pads. You can also get protective foot cushions that sit over the skin to prevent the hallux abducto valgus rubbing on your shoes.
Bunions can cause pain and difficulty wearing certain shoes. When simple treatments don't relieve your symptoms, surgery may be considered for treatment of the bunion. What are the signs that surgery may be the right treatment for your bunion? In general, surgery is recommended only when pain from the bunion prevents a patient from wearing normal shoes. There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.
Bunions often become painful if they are allowed to progress. But not all bunions progress. Many bunion problems can be managed without surgery. In general, bunions that are not painful do not need surgical correction. For this reason, orthopaedic surgeons do not recommend "preventive" surgery for bunions that do not hurt; with proper preventive care, they may never become a problem.