What Is A Hammertoe?
A hammertoe is a deformity that usually affects one or more of the toes. As the hammer toe deformity increases, the joint just in front of it often becomes contracted as well. This can lead to the coexistence of a hammer toe together with a painful callous on the ball of the foot. The toe curls or buckles under, which in turn causes the toe to contract or shorten in length. These deformities are usually either flexible or rigid and they be a result of a bone spur.
Hammertoes may be caused by heredity, high-arched or weakened foot muscles, or other deformities of the foot such as a bunion. The bunion may cause the second toe to contract and move, and even overlap the big toe.
Often times, as both of these deformities progress, pain may also develop on the ball of the foot, and this will lead to the development of a thickened area of skin or callous formation on the bottom of the foot.
What Is A Callous?
Callouses are hyperkeratotic regions of the skin or thickened regions of the skin that result from increased pressure of the bones on the bottom of the foot, commonly in the region of the ball of the foot. These usually occur as a result of some malalignment or increased pressure on various metatarsal bones. As a result of increased curling of the toe as seen in hammertoes, increased pressure develops as the metatarsal bone undergoes malalignment.
Treatment For Corns, Hammertoes, and Callouses
First line treatment for Corns, Hammertoes, and Callouses involves alteration of shoe gear. Seek out a shoe with a deeper and/or softer toe box. Certainly, shoes with rubber soles are preferable for people with callouses than shoes with hard and unyielding soles. Several crams can aid in softening hyperkeratosis. For callouses, a safe and effective addition to using cream is buffing pads. This is best used in the shower/bath on an as needed basis and will effectively help to reduce callous formation. It is especially useful in the heel location. Some people develop corns between their toes, gel spreaders are often helpful in preventing irritation between these parts. A device that can be used to temporarily reduce the contracture of a hammertoe is toe straightener. This can be used while wearing most shoes. Hammertoes can cause significant irritation on the top of the toes, especially with patients who are elderly, diabetic, or who experience circulation problems such as peripheral arterial disease. These people may find benefit from the temporary use of post op shoes. People with callouses on the bottom of the feet may also benefit from the addition of an orthotic/insole to their sole. Well padded soft orthotic is especially good for people who feel a lack of padding on the bottom of their feet, who sometimes may feel as if they are walking on their bones. People with arthritis may also find this product to be beneficial. People with an adequate cushion on the bottom of their feet that suffer from callouses will find benefit from the use of an orthotic that will provide biomechanical control to help resolve this condition. If you additionally have a severe flatfoot, the more rigid insole would be most beneficial.
It is generally not recommended on the use of medical corn removers, such as any type of product with salicylic acid to remove the corn or callous. We feel that these products may lead to the development of more complicated problems, especially in patients with diabetes and any degree of poor circulation.
If the above methods do not prove to be effective, you should seek in person professional medical evaluation. This will generally involve obtaining an appropriate medical history, x-rays, and clinical examination, especially evaluation of the circulatory system. A physician may attempt shaving of the hyperkeratosis / debridement, whether it be a corn or a callous. Certain times, if a corn or hammertoe is inflamed, an injection may prove beneficial. Custom made orthotics may also be recommended.
In cases where the above treatments do not prove to be satisfactory, surgery is often recommended. In the case of a corn, again these are mostly due to an actual digital deformity, ie. hammertoe, therefore the correction of the hammertoe will result in removing the corn. Surgery for this condition generally involves removal a small portion of bone and reducing the contracture of the soft tissues on the toe. Many hammertoe deformities are treated by a procedure known as arthrodesis or fusion. In this particular procedure, a k-wire is often used to hold the toe in a corrected position while allowing the realigned joint to fuse. In this fashion, the toe becomes straight and functions more biomechanically efficient. Hammertoe fusions can often help resolve one's callous problems as well, by virtue of this alteration of mechanics. In cases of more intractable calousses the metatarsal bone may sometimes prove to be either elongated or even positioned downward. In these cases, a metatarsal osteotomy is often required. This procedure involves a specifically designed angulated cut of the metatarsal bone that reduces the elongation of the bone and realigns the bone in an more ideal position. There are several methods that contemporary foot and ankle surgeons use to fixate this bone cut / osteotomy. The Wiel Osteotomy is a common surgical procedure performed for the treatment of this problem.