The feet bear the weight of the whole body when walking. Unfavorable footwear is therefore fatal for the feet. High heels, stilettos etc. in particular have a negative impact on foot health. More than half of women wear shoes that are at least half a size to one size too small for the length of their feet.
As a result of an unsuitable choice of shoes, misalignments of the toes often occur, which are known as hammer toes and claw toes. Changes in the skeleton of the foot (fallen arches, bunions) can also cause such deformities. In rare cases, other diseases, such as
- neurological diseases,
- chronic polyarthritis or
- fractures in the lower leg or ankle joint
are the cause.
In a hammer toe, the toe is bent so far at the end joint that the toe bone points towards the ground like the head of a hammer. The second toe is usually affected. In severe cases, the misalignment of the joints causes several toes to overlap.
In hammer toe, the second toe is usually bent downwards © Henrie / Fotolia
Claw toes are to be distinguished from hammer toes. With this deformity, the affected toe is hyperextended in the metatarsophalangeal joint and simultaneously flexed in the middle and distal joints. As a result, the toe curves upwards like a claw and the tip of the toe loses contact with the ground.
The hammer toe is often accompanied by other foot deformities, such as the
- flat foot,
- hollow foot or
- hallux valgus (malposition of the big toe).
In the early stages, hammertoes usually cause no symptoms. Those affected often only go to the doctor because they no longer find their foot visually appealing. However, if the deformity progresses, irritation can occur in the affected areas, resulting in
- Pressure pain,
- calluses and
- corns, usually over the metatarsophalangeal joint.
If the rubbing leads to skin lesions, infection can also occur. This is associated with risks such as blood poisoning and bone inflammation. In the worst case scenario, they may require amputation. It is then often no longer possible to wear normal shoes.
The deformation can also displace other toes. This can lead to toes being dislocated in their base joints (luxation).
In order to determine how pronounced the deformation of the toes is, an X-ray examination is carried out. This allows the doctor to see
- how far the deformation has progressed,
- which joints are affected and
- whether toe luxations are already present.
The x-ray also shows whether any inflammatory changes(arthritis) are associated with the deformity.
Under certain circumstances, the doctor can try to treat the symptoms using conventional methods, i.e. without surgery. To do this, the toes must not yet be completely stiffened and the toes can still be passively stretched.
The following treatment options are available:
- Elimination of the cause,
- physiotherapy,
- manual therapy,
- orthopaedic insoles,
- Padding and care of the pressure points (pressure protection and positioning orthoses),
- rein bandages,
- selection of special soft leather shoes, shoe customization and orthopaedic standard shoes, as well as
- specially made footwear
Over time, the deformity often becomes rigid and correction with the above measures can no longer be achieved.
In the advanced stage of hammer toe, chronic inflammation and stiffness develop. These complaints can have a major impact on everyday life. Patients should then consider an operation by a foot surgeon.
The surgeon has several options for treating a hammer toe:
- Straightening the toe,
- Lengthening or relocating the tendons,
- Removal of part of the bone,
- separation and displacement of the bone, and/or
- stiffening of the joint.
The surgical procedure can often be performed on an outpatient basis.
The doctor can advise you on various surgical methods. The choice depends on
- how severely the toe is bent or stiffened,
- the causes and other deformities/disorders of the foot and
- whether the joint can still be moved.
Arthrodesis
This method involves a surgical stiffening of the joint. It can be used for hammer toes with complete fusion or in cases where several toes are affected.
In an arthrodesis, the joint is strengthened (after straightening) using a wire, a metal staple or an implant .
The advantage of this method is less pain and a lower risk of edema formation. However, the follow-up treatment can take a little longer.
Hohmann operation
In this surgical method, the surgeon shortens the toe bone by removing the proximal phalanx involved in the joint. He then stretches the flexor tendon. This creates a new joint and corrects the position of the toe. This is why the method is also called resection arthroplasty.
The toe may have to be fixed for a few weeks with a wire that is visible from the outside. The shortening of the bone section relieves the soft tissue section.
The disadvantages of this method are a higher risk of swelling and the risk of painful irritation in the joint.
The advantages, however, are the shorter post-treatment time and the relatively simple technical procedure.
Tendon displacements
If hammertoes are still mobile without any relevant additional deformity, tendon relocation is possible.
The procedure is only performed on the soft tissue, not the bone. If the operation is successful, the individual toes can be moved. This reverses the flexion of the toes into an extension and thus corrects the deformity without stiffening.
Shortening of the metatarsal bones (e.g. Weil osteotomy)
In these traditional procedures, such as the Weil osteotomy, a metatarsal bone is shortened. This may be necessary to better balance the load on the forefoot between the different bones. In this way, a dislocated (luxated) bone in the joint can also be repositioned.
A biomechanical analysis can also be useful before such an operation. This allows the surgeon to recognize whether there is a possible strain on a particular region.
Minimally invasive operations
In recent years, minimally invasive procedures have also become established for hammer toe. The doctor only makes small incisions in the skin and uses special techniques. This allows him to avoid a major operation and often also makes follow-up treatment easier for the patient.
Your foot surgeon will explain to you whether such an operation is an option for you.
