The name Hammertoe
comes from the way the tip of the toe hits or hammers on the floor with each step. The primary deformity seen in a hammer toe is found at the PIPJ (proximal interphalangeal joint) which is the first or more proximal of the two joints of the toe. A mallet toe, on the other hand, is a similar deformity but is found in the DIPJ (distal interphalangeal joint). And lastly, claw toes are a deformity where the entire toe grabs and involves the MPJ (metatarsal phalangeal joint) PIPJ and DIPJ. Collectively, these deformities are referred to as hammer toes. Hammer toes can affect one or all of the toes simultaneously.Causes
Ill-fitting shoes or a muscle imbalance are the most common causes of Hammer Toe. If there is an issue with a muscle in the second, third or fourth toes preventing them from straightening, Hammer Toe can result. If one of these toes is bent long enough in one position, the muscles tighten and cannot stretch out. Left untreated, surgery may be required. Women are especially prone to developing Hammer Toe because of their shoes. Hammer Toe results from shoes that don?t fit properly. Shoes that narrow toward the toe, pushing smaller toes into a bend position for extended periods of time. High heels that force the foot down into a narrow space, forcing the toes against the shoe, increasing the bend in the toe.Symptoms
The middle joint of the toe is bent. The end part of the toe bends down into a claw-like deformity. At first, you may be able to move and straighten the toe. Over time, you will no longer be able to move the toe. It will be painful. A corn often forms on the top of the toe. A callus is found on the sole of the foot. Walking or wearing shoes can be painful.Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.Non Surgical Treatment
Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area. Wear a shoe with a deep toe box. If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician?s office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly. See your podiatric physician if pain persists.Surgical Treatment
As previously mentioned it?s best to catch this problem early; hammer toe taping is relatively harmless and simple. Long term complications can cause foot deformities and even difficulty walking. It?s always best to stiff shoes and high heel, especially if you?re working on hammer toe recovery. Pick comfortable shoes with plenty of toe space. Prevention is the best cure here as this injury is nearly always self inflicted.
Uneven muscle tension results in the distortion of one or several of the Hammer toe
small toes. (Hammer toe
) Pressure points develop at the raised middle joint as well as at the tip of the toe and underneath the metatarsal head. In the beginning, when the misalignment can still be corrected, it often suffices to lengthen the tendon and to cut a notch into the capsule. In a contracted misalignment, part of the middle joint is removed to form a replacement joint. Modern surgical techniques preserve the metatarsophalangeal joint (Weil or Helal osteotomies).Causes
Your toe contains two joints that allow it to bend at the middle and bottom. A hammertoe occurs when the middle joint becomes dislocated. Common causes of this joint dislocation include a toe injury, arthritis, a high foot arch, wearing shoes that don?t fit properly, tightened ligaments or tendons in the foot, pressure from a bunion (when your big toe points inward toward your second toe) Spinal cord or peripheral nerve damage may cause all of your toes to curl downward.Symptoms
People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.Diagnosis
The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.Non Surgical Treatment
There are many non-surgical treatments to help relieve symptoms of hammertoe. The first step for many people is wearing the right size and type of shoe. Low-heeled shoes with a boxy or roomy toe area are helpful. Cushioned insoles, customized orthopedic inserts, and pads can provided relief as well. Splints or straps may be used to help correct toe position. Your doctor may show you toe stretches and exercises to perform. Your doctor can safely remove corns and calluses. You should not try to remove them at home.Surgical Treatment
he basis for hammer toe surgery most often involves removing s portion of bone within the toe, to reduce the joint contracture. Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.
The term "hallux valgus" or "hallux abducto-valgus" are the most commonly used medical terms associated with a bunion anomaly, where "hallux" refers to the great toe, "valgus" refers to the abnormal angulation of the great toe commonly associated with bunion anomalies, and "abductus/-o" refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunions. It is important to state that "hallux abducto" refers to the motion the great toe moves away from the body's midline. Deformities of the lower extremity are usually named in accordance to the body's midline, or the line bisecting the body longitudinally into two halves. In more severe cases, the hallux continuing in the abductus fashion eventually either overlaps or underlaps subsequent lesser (small) toes especially the second (adjacent toe). Causes
Women are particularly at risk for bunions, as high heels may help aggravate the condition. Bunions may also be caused when bursal sacs, sacs that absorb friction and lubricate the many tendons, bones muscles of the body, in the foot become inflamed or swollen. Bunions may also be prompted by the metatarsal bone, the bone that runs from the heel to the toe of the foot, with one metatarsal bone leading to each toe, of the big toe enlarging or deviating slightly to the outside of the foot. Symptoms
Patients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper. Diagnosis
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required. Non Surgical Treatment
Pain is the main reason that you seek treatment for bunion. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to off-load the bunion. As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length. Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, a bunion splint or orthotic. Your physiotherapist is an expert in the techniques that will work best for you. Your foot posture muscles are vital to correct the biomechanics that causing your bunion to deteriorate. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs. During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals. Bunions will deform further with no attention. Plus, the bunion pain associated does have a tendency to return. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes. Your physiotherapist will guide you. Surgical Treatment
Complications of bunion surgery are not common, but include infection of soft tissue and/or bone, slow healing of skin or bone, irritation from fixation pins or screws, nerve entrapment, reaction to the foreign material (suture material, pins or screws), excessive swelling, excessive scarring, excessive stiffness (some stiffness is unavoidable), over-correction (hallux varus) and recurrence of the deformity. Rarely, some complications may require a second surgery to correct the problem. While these complications are rare, they should be weighed against the difficulty that you are experiencing to determine whether surgery is an acceptable risk for your condition. This is an important part of the process. Prevention
Make better shoe choices. If you?re a woman, avoid high-heeled footwear whenever possible (at the very least, choose shoes with heels lower than two inches), and make sure all your footwear has a wide, deep toe box. Whether man or woman, if you?re trying on shoes and your toes feel ?squished? or crowded by a particular shoe, reject that style and try another, or go for a larger size. You don?t need to invite trouble. In general, shoes that come to a point at the toe are bad news, as they tend to push the toes together into an overlapping pattern. Shoes with rocker soles will unload pressure on the bunion area. Examine your feet regularly. Note any redness, swelling or discoloration. Flex your toes and check for any stiffness. If there is any, think back to what you?ve worn or done in the past few days. If the condition persists more than a few days, or worsens, a visit to the podiatric physician is in order.
Overpronation is when the foot rolls in excessively, or at a time when it should not, for instance late in the stance phase of gait. In this case much weight is transferred to the inner or medial side of the foot, and as the runner moves forward the load is borne by the inner edge rather than the ball of the foot. This destabilises the foot, which will attempt to regain stability by compensating for the inward movement. In a kind of chain reaction, this in turn affects the biomechanical efficiency of the leg, especially the knee and hip.Causes
There are many possible causes for overpronation, but researchers have not yet determined one underlying cause. Hintermann states, Compensatory overpronation may occur for anatomical reasons, such as a tibia vara of 10 degrees or more, forefoot varus, leg length discrepancy, ligamentous laxity, or because of muscular weakness or tightness in the gastrocnemius and soleus muscles. Pronation can be influenced by sources outside of the body as well. Shoes have been shown to significantly influence pronation. Hintermann states that the same person can have different amounts of pronation just by using different running shoes. It is easily possible that the maximal ankle joint eversion movement is 31 degrees for one and 12 degrees for another running shoe.Symptoms
Over-pronation is a condition where the arch flattens out which makes the feet roll inward while walking. This condition is also known as flat feet. It imposes extreme additional stresses on the plantar fascia, a fibrous band of tissue which connects the heel to the forefoot. Over-pronation makes walking a painful experience because of the additional strain on the calves, heel and/or back. Treatment for over-pronation involves the use of specially-made orthotics which offers arch support and medial rear foot posting as corrective measures.Diagnosis
At some point you may find the pain to much or become frustrated. So what are you options? Chances are your overpronation has led to some type of injury if there's pain. Your best bet is to consult with someone who knows feet. Start with your pediatrist, chiropodist or chiropractor. They'll be able to diagnose and treat the injury and give you more specific direction to better support your feet. One common intervention is a custom foot orthotic. Giving greater structural support than a typical shoe these shoe inserts can dramatically reduce overpronation.Non Surgical TreatmentOver-Pronation
can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.Surgical Treatment
Calcaneal "Slide" (Sliding Calcaneal Osteotomy) A wedge is cut into the heel bone (calcaneus) and a fixation device (screws, plate) is used to hold the bone in its new position. This is an aggressive option with a prolonged period of non-weightbearing, long recovery times and many potential complications. However, it can and has provided for successful patient outcomes.
disease or calcaneal apophysitis causes heel pain usually in growing children between age nine and fourteen. It occurs as a result of disturbance during the final development of the heel growth plate. During this time the achilles tendon is pulling strongly on the heel bone and this excessive force can cause inflammation and pain.Causes
Sever's disease can result from standing too long, which puts constant pressure on the heel. Poor-fitting shoes can contribute to the condition by not providing enough support or padding for the feet or by rubbing against the back of the heel. Although Sever's disease can occur in any child, these conditions increase the chances of it happening. Pronated foot (a foot that rolls in at the ankle when walking), which causes tightness and twisting of the Achilles tendon, thus increasing its pull on the heel's growth plate, flat or high arch, which affects the angle of the heel within the foot, causing tightness and shortening of the Achilles tendon, short leg syndrome (one leg is shorter than the other), which causes the foot on the short leg to bend downward to reach the ground, pulling on the Achilles tendon, overweight or obesity, which puts weight-related pressure on the growth plateSymptoms
A few signs and symptoms point to Sever?s disease, which may affect one or both heels. These include pain at the heel or around the Achilles tendon, Heel pain during physical exercise, especially activities that require running or jumping, worsening of pain after exercise, a tender swelling or bulge on the heel that is sore to touch, calf muscle stiffness first thing in the morning, limping, a tendency to tiptoe.Diagnosis
Your Podiatrist or Physiotherapist will assist in diagnosing the injury and the extent of the damage. From this, they will develop a management plan which may include rest or activity modification, soft tissue treatment such as massage and stretching, correction of biomechanics through heel raises or orthoses and the progression through a series of specific strengthening exercises.Non Surgical Treatment
Treatment of Severs
disease usually involves a combination of an accurate analysis of your child?s gait, muscles, tendons, ligaments and joints is a crucial first step. Specific stretching and strengthening exercises often make up part of the treatment. Anti-inflammatory measures such as ice baths after exercise can be helpful in the short term. Footwear review, assessment and advice is important. Orthotic devices are often needed to firstly control any abnormal traction or tension on the heel growth plate and, secondly, too unload the ground reaction forces on the heel bone. Podiatry Care has podiatrists with specific paediatric training enabling them to utilise treatment options to relieve heel pain in children very quickly. If your child is struggling to play sport, see a Podiatry Care podiatrist near you. In severe cases modification to activity levels may be required. Treatment of Severs
disease does NOT require surgery. This foot condition responds very well to conservative treatment.