This condition usually affects the lesser toes. Women are more commonly affected than men. The toe looks bent upwards at the first joint, giving it the appearance of an upside down V when looked at from the side.
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At the early stage the condition is known as a flexible hammertoe as the joint is still moveable and relatively treatable. In a more developed stage they are known as rigid hammertoes, the joint becomes immovable as the term suggests.
This is normally seen in patients where the condition has been left untreated for a long time and/or patients with severe arthritis. The tendons in the toe and foot become tight and can be felt like steel bands in the soft arch. Corrective surgery is usually the only option when the condition has reached this stage.
What causes a hammertoe?
Factors causing hammertoes can be hereditary factors, trauma to the foot or arthritis. Structurally there is an imbalance of the muscles of the toes, some muscles being to short or tight and others being to long or lax. This causes increased pressure on the tendons and joints of the toe, causing the toe to bend or contract up at the first joint.
Another cause that some patients (ladies who love their high-heeled shoes!) refuse to acknowledge is inappropriate footwear. Shoes that are too tight or with a raised heel can put more weight on the front part of the foot, effectively squeezing the toes into an abnormal position. This can over time become the ‘normal’ position for the toes.
Have I got a hammertoe?
The first symptom of a hammertoe is the bent appearance of the toe. This can be accompanied in varying degrees by pain and/or corns on the top of the toe from contact with the shoe, as well as possible redness and swelling of the joint.
The movement of the joint can also have restricted and/or painful movement together with pain in the ball of the foot at the base of the affected toes.
How is hammertoe treated?
The earlier the condition is treated of course, the less severe and non-surgical the treatment is likely to be.
Caught early, the affected toes can either be strapped and/or padded (a small flexible cushioning under the toe). Both these options will help to reduce pain and control the imbalances.
As daily strapping can be quite tedious, a better option would be an orthotic device made by a podiatrist. This insert is placed in the shoe to help correct the position of the toes and will help prevent the worsening of the condition over the long term. This insert can also help reduce the pain and discomfort.
Initially, anti-inflammatory drugs and cortisone injections can be prescribed to ease the pain and inflammation of the joint.
At an advanced stage, surgery to reduce the bony prominence and pull the toe straight is really the only option. This can be a complex and painful experience, but it is restorative.
Can hammertoes be prevented?
You can do a great deal to help prevent and control the condition. Loose fitting footwear with a deep toe box and a relatively small heel (4-5cm max.) will help reduce the pressure considerably.
Wearing an over the counter, non-medicated hammertoe pad available from your pharmacy can also reduce pressure on the affected area. Ice packs can be applied to painful and/or inflamed toes to reduce swelling. The best course of action would be to seek timely professional advice from your podiatrist. If left too long, the condition could become crippling.
(Written by Dallas Fell and Chris Delpierre, registered podiatrists with the H.P.C.S.A)
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