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UpgradeThe term hammer toe is used when a lesser toe appears bent. When it can be straightened we call it flexible and if not able to then we call it fixed. Usually one or two toes will be affected. These look worse on standing. The causes maybe due to subtle muscular imbalance, longer lengths of the lesser metatarsals especially the second, poorly fitting shoes and gradual deviation of the first toe otherwise called as bunion in lay terms.
Claw toes appear to look the same as hammer toes but it is a term used when all lesser toes are affected and usually have a background neuromuscular cause. These too can be either flexible or fixed. Similar causes as above including poorly fitting shoes, overcrowded toes and the background neurological condition create these deformities and can cause progression.
Common complaints are of pain, redness or corns on top of the bent toe especially after standing and working all day in shoes. Also one can develop an end corn at the tip of the bent toe just below the nail. Sometimes one can have pain at the ball of the foot in relation to the hammer or claw toe.
Treatment is generally initially by giving advice on using better fitted shoes, wider toebox , softer uppers of the shoes, straps and sometimes internal pads in the insoles. Most of these generally do not work well. If these measures fail then surgical correction of these toes is indicated. The surgical treatment is based on whether these toes are flexible or fixed.
If they are flexible soft tissue procedures generally suffice where the guiders(tendons) are either lengthened, released or transferred to balance the guiders.
If the hammer or claw toe is fixed, then one needs to fuse the first joint called the PIPJ and held with a wire which is cut and bent at the tip of the toe with or without soft tissue procedures.
The aims of surgical treatment is to place the toes as straight as possible especially on standing and shoewear can be tolerated and made comfortable. The toes will still move at the joint above otherwise called as the MTPJ and the one lower called the DIPJ. The patient also will not have the problems of corns and pain associated with them.
Most patients recover well as the physios in the ward will get them walking and exercising the ankles and knees.
All these surgeries are done as day cases and the patient can go home the same day. They need to bring their medications and the prescription. It is advisable for the patient to have showered that morning and to wear clean socks.
The surgeon will discuss the type of surgery needed and will inform you of the results and complications that can happen.
Treatment is considered when non operative measures have failed and the patient has symptoms of pain.
The foot and ankle are an intricate system of 28 bones, 33 joints, 112 ligaments and numerous muscles. This complex system is capable of bearing weight and navigating uneven terrains.
One Health Group utilises specialist consultants and healthcare managers working together to provide the best possible diagnosis and treatment for our patients.