Anatomy and Cause of a Hammertoe
A hammertoe is an unnatural upward or sideways bending in the toe. This abnormal position of the toe can cause pain, loss of movement, or skin sores from rubbing. A hammertoe can be caused by either certain imbalances within the leg/foot or overactive muscles due to a flexible foot. Hammertoe symptoms may be made worse with tight fitting shoes, narrow shoes or serenous activity. The risk of developing a hammertoe increases with age and the development of certain diseases such as diabetes and arthritis.
In the beginning stages, a hammertoe may still be flexible. However, as time goes on the tendons in the toe may begin to tighten and contract, leading to adaptive changes in the toe’s joint structure. These changes can cause the toe to lose movement and become permanently stiff or rigid.
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Advanced stages of hammertoes may result in a toe moving to the right or left at an angle. The hammertoe may cross over an adjacent toe and will occasionally rest on top of another toe. This can make it difficult or painful to wear socks and shoes. Sores and even open wounds can develop from this unnatural position. During this advanced stage of a hammertoe, an additional structure within the toe called the plantar plate becomes damaged. In a typical toe the plantar plate helps keep the toe in a straight position. When the plantar plate becomes torn, the toe is allowed to float upwards and is unable to touch the ground. Many times the joint at the base of the toe is also painful and swollen. Dr. Castelein always evaluates the hammertoe for possible plantar plate tear and addresses this injury as needed.
Conservative Treatment for Hammertoes
These shoe buying tips may help you avoid excess hammertoe pain!
Advanced Treatment Options for Hammertoe
Depending on the severity of the deformity and amount of pain associated, Dr. Castelein may recommend outpatient surgery to correct your hammertoe. The type of procedure chosen will depend upon imaging results and will be discussed in detail with Dr. Castelein.
Arthroplasty: This surgical procedure is very commonly performed for correction of hammertoe deformities. Dr. Castelein increases the joint space of the affected toe. This allows for the toe to sit in a better position without rubbing or pain on the top of the toe.
Arthrodesis: Hammertoe arthrodesis is an established surgical procedure usually recommended when osteoarthritis is present or other methods have failed. Dr. Castelein will remove damaged bone before fusing the small joint within the toe. Arthrodesis ensures the toe joint remains in a fixed, solid position thereby removing the ability of the hammertoe to return. New implants reduce the need for surgical wire insertion in the toe allowing for a faster recovery period.
Plantar Plate Repair: Floating or cross-over hammertoes often have an additional injury to the plantar plate. The plantar plate is a thick band on the bottom of the toe. When these toes are corrected, Dr. Castelein will first correct the position of the toe with either an arthroplasty or arthrodesis procedure as discussed above. Dr. Castelein then has to correct the plantar plate through a small bone cut called a weil osteotomy which allows him to access the plantar plate. He then repairs any tears in the plantar plate and tightens the plantar plate back to the bone restoring its function. This retightening is achieved through sutures and bone anchors very similar to procedures performed in ankles, knees, and shoulders.
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