By Gilda Morales, ANP, DC
Today’s column deals with a condition that occurs much more often in females than in males, hammertoes, which are defined as deformities of the second through fifth toes, but more commonly, the second toe. The risk of developing hammertoes increases with age and affects blacks more that whites. The cause can be congenital or inherited, or it can be acquired as a result of trauma or wearing shoes that are too narrow or tight. Rheumatoid arthritis is another common cause of hammertoes as is diabetes.
Diagnosis is made primarily by clinical presentation and weight bearing x-rays of the feet. The goal of treatment is to relieve the patient’s symptoms and assist a return to normal activities through nonsurgical and surgical interventions. Nonsurgical treatment may be as simple as wearing shoes that are wider at the toe, special padding of the hammer toe, orthotics that are specific for straightening the hammer toe and taping to reduce hammer toes that are still flexible. If the patient’s gait is somewhat abnormal, shoe orthotics can help and physical therapy can help by stretching and strengthening the toes to maintain flexibility.
Hammertoes are not just a deformity, they are usually painful and respond well to NSAIDs such as Ibuprofen, naproxen and to corticosteroid injections in those cases where there is profound soft tissue inflammation. In cases where these conservative measures fail, then a referral to a podiatrist or orthopedic surgeon is suggested. Surgical intervention and specific procedures depend on the severity of the deformity.
The most common intervention is the PIP joint arthroplasty, which involves removing a piece of the bone of the toe to give the toe room to straighten out. This surgical procedure takes about 6 to 8 weeks to recover. Other procedures involve lengthening the tendons or implanting normal bones to replace the deformed ones. In any case, however, prevention is much easier and less painful by avoiding wearing heels, pointed toe shoes or shoes that are too narrow.