Bunions and Hammertoes
Bunions and Hammertoes

What Is Hammertoe?

Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with non-invasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

Non-surgical Treatment

There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.

A number of non-surgical measures can be undertaken

Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.

Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels – conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.

Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.

Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.

Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.

When Is Surgery Needed?

In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis we will obtain a thorough history of your symptoms and examine your foot. During the physical examination, we may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, we may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Hammertoes are progressive – they don’t go away by themselves and usually they will get worse over time. However, not all cases are alike – some hammertoes progress more rapidly than others. Once we have evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

What Is Bunion?

A bunion, also called Hallux Valgus, is a deformity of the big toe. A bunion is the condition where the big toe is angled excessively towards the second toe and a swollen, bony lump appears on the outside edge of your foot. Typical bunion symptoms occurs as the condition gets worse with the big toe rubbing against the second toe and pushing it out of place. The bunion also starts pressing against the shoe and you feel swelling and pain in the affected area from rubbing. In addition, because the big toe does not work properly with a bunion, the other smaller toes have to take more burden of your body weight as you move, which leads to further discomfort or pain. As bunion symptoms increase your foot may become wider so it is difficult to find properly fitting shoes. So it is important to consider appropriate care( Non-Surgical Bunion Treatment ) for your bunion to reduce these symptoms before it is too late.

Symptoms

Signs and symptoms of a bunion include

  • The base of the big toe is swollen and sticks out.
  • The big toe is often bent towards the other toes, and sometimes the second toe is pushed to overlap the third toe.
  • Skin around the big toe joint is red and sore.
  • Thickened skin at the base of the big toe.
  • Pain in the big toe or foot.
  • Wearing shoes is painful.
  • Pain or difficulty when walking.
Causes and risk factors

Causes of bunions and risk factors for bunions include

  • A family tendency to bunions may make them more likely to develop.
  • Arthritis of the foot - if it affects walking, it can make bunions more likely to develop.
  • Neuromuscular problems, such as cerebral palsy.
  • Biomechanical factors, such as low arches, flat feet and hypermobile joints, can increase the risk.
  • Wearing shoes that are too tight, too narrow and with pointed toes will exacerbate symptoms if bunions are present.
  • Wearing high heels will also exacerbate existing bunions.
  • Women are more prone to bunions than men.
Treatment
Correct footwear

Most bunions can be treated without surgery. The first step for treating bunions is to ensure that your shoes fit correctly. Often good footwear is all that is needed to alleviate the problem. Shoes that are wide enough to avoid pressure on the bunion are the obvious first step. Look for shoes with wide insteps and broad toes and definitely no high heels. Sometimes, you can get your existing shoes stretched out by a shoe repairer. Seek advice from a podiatrist.

Pads and toe inserts

Protective bunion pads may help to cushion the joint and reduce pain. Toe inserts are available that splint the toes straight. It may be recommended that you wear some orthotics to improve your foot position when walking.

Medicines

Some people find anti-inflammatory medicines, such as ibuprofen or aspirin, or paracetamol help ease the pain of their bunions.

Surgery

For more severe cases, surgery may be necessary. Bunion surgery aims to bring your big toe back into its correct position. Several different surgical procedures have been used to treat bunions. These include 'shaving' excess bone, removing the end of one of the bones or breaking and re-aligning the misplaced bone. Rehabilitation from bunion surgery can be quite long and usually involves you keeping off your foot for some weeks. It may take a year or more for complete recovery.