Hammertoes
Background
Hammertoes are scrunched-up or crooked toes resulting in:
Toes that rub together or overlap
Gaps between the toes
Bony bumps on the tops, bottoms, or sides of the toes
Calluses or ulcerations
Pain in the toes or ball of the foot
Difficulty with shoe wear or walking barefoot
Hammertoes are caused by tendon or ligament imbalances, such that the small joints of the toes become deformed. The imbalances result from nerve, muscle, or joint damage, which can be associated with rheumatoid arthritis, osteoarthritis, peripheral neuropathy, diabetes, or other conditions. Constricting shoe wear can also contribute.
Hammertoes occur most commonly in the 4 smaller toes, and are very commonly associated with bunions or arthritis of the big toe. Hammertoes become more common and more severe as we age.
This patient has hammertoes of the smaller 4 toes and a bunion of the big toe on her right foot. Her left foot has similar problems but is less severe.
Examples of hammertoe splints, hammertoe sleeves, toe spacers, and corn pads.
Nonsurgical Treatment
Nonsurgical treatment for hammertoes consists of splints, sleeves, pads, and taping to help relieve points of pressure. If you want, these are things you can try before you come in! If you do, please bring them with you to the office at your first visit. Below are a few links to outside websites for things to try:
Hammertoe taping
Please note that splints, sleeves, pads, and taping can sometimes relieve symptoms, but they are not designed to correct the deformity or cure the disease.
Surgical Treatment
Ultimately, the only real “cure” for hammertoes is surgical straightening. Dr. Bohl does hammertoe straightening through a series of cosmetic incisions on the top of the foot. The smaller, less important joint in the toe that has become dysfunctional (the “proximal interphalangeal joint”) is fused straight. The larger, more important joint in the toe (the “metatarsophalangeal joint”) is rebalanced with ligamentous repair and tendon lengthening to help it move and rest more appropriately. Temporary pins are placed into the tip of the toe to help hold it straight; these are removed in the office after 4 weeks, which is quick, easy, and painless. After surgery, you can walk immediately; however, you should keep your foot elevated as much as possible for a week or so.
The toes are small, but hammertoe surgery is paradoxically one of the most technically demanding surgical procedures an orthopaedic foot and ankle surgeon performs. This is because of the great attention to detail required for an excellent result. Small imperfections in alignment result in major annoyances for patients. Dr. Bohl craves these nuances and thrives on creating a perfectly aligned forefoot that is pain free. It is critical that you choose an orthopaedic surgeon with extensive experience correcting hammertoes and who appreciates the importance of getting it right the first time.
Postoperative x-ray of hammertoe correction of the smaller 4 toes. The pins hold the toes straight for 4 weeks and are then removed easily in the office.
Dr. Bohl discusses the risks and benefits of revision hammertoe surgery with a patient.
Revision Surgery
Unfortunately, Dr. Bohl sees many patients who are dissatisfied with hammertoe procedures they have had in the past. Oftentimes the deformity recurs or a different deformity develops. Sometimes this occurs quickly, and sometimes not for many years.
Such patients require revision surgical procedures that are even more technically demanding than the original procedures due to the complexities of prior surgical incisions, damaged tissue, bone loss, hardware, and concurrent problems.
If you have had prior hammertoe surgery and are dissatisfied, Dr. Bohl would enjoy discussing your result with you in clinic. Additional surgery may or may not be worthwhile, and Dr. Bohl will discuss the risks and benefits in the context of your lifestyle, priorities, and goals.