DEAR DR. GOTT: I am a 59-year-old female. I have developed two hammertoes on my left foot and one on my right foot during the past three months. I went to a podiatrist, who advised me to use a cold pack for 20 minutes three times a day and to wear only athletic shoes. He also advised me not to go barefoot. I paid $23 for a pair of shoe inserts made of compressed foam, which he made during my visit. I am still experiencing the same level of discomfort. The stabbing pains are in the affected toes and the balls of my feet. The pain even awakens me during sleep. Can this condition be surgically corrected? Do you have any suggestions for a less invasive treatment?
DEAR READER: Hammertoe is a condition in which the affected toe or toes become bent at the middle joint. The middle joint bends upward, while the tip curls downward into a characteristic hammer or clawlike shape.
The most common cause stems from wearing shoes that are too small or heels that are too high. These types of footwear do not provide adequate space for the toes to lie flat, thus pushing one or more forward in an unnatural, bent position. Some cases may be inherited and will develop no matter what kind of shoes you wear.
The early sign is a toe that curves abnormally but is still flexible and lies flat when not wearing improper footwear. Over time, the repeated use of these shoes will cause the tendons to contract and tighten, causing the toe to become bent and stiff permanently. Other symptoms include pain and difficulty moving the affected toe, pain with walking or other foot movements and the development of corns or calluses caused by the constant rubbing against the shoe.
Treatment depends on the severity of the deformity. In the early stages, simply wearing more comfortable, wider shoes and using special shoe inserts or pads may be all that is necessary; however, once the hammertoe has become inflexible, surgery is recommended. There are two types of procedures, depending on the remaining flexibility. If movement is possible, the surgeon may simply release the affected tendon though an incision in the toe. If the toe is completely rigid, a more complicated procedure might be performed. In this case, the affected tendons will need to be cut or realigned, and portions of the bone may be removed to allow for straightening.
The good news is that both are relatively minor procedures, and most patients will be discharged on the same day. Once you’re home, it is important to take proper care to avoid further damage to the toe. Specifically, don’t repeat the same mistakes that caused the hammertoe in the first place. Wide, flat shoes, such as sneakers, are preferable during recuperation and afterward. Stretching the toe muscles and performing strengthening exercises, such as picking up marbles with your toes, may be recommended.
If your pain persists following the podiatrist’s suggestions, return to him to discuss further treatment options. Or you could get a second opinion.
To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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