Hammer Toe Orthopedic Surgery

Hammer toe or contracted toe is a condition where the proximal interphalangeal joint of the second, third or fourth toe is bent awkwardly in the manner of a hammer. This often causes pain and difficult movement. Often, those with hammer toe can tolerate the problem or wear special shoes which allow for easier movement and alleviate pain. But in severe cases, the condition can be dealt with either temporarily or permanently via orthopedic surgery.

Surgical Candidates[edit]

A surgical podiatrist or foot-and-ankle specialized orthopedic surgeon determines if someone is a candidate for an invasive orthopedic procedure. They will typically examine the patient’s toe, determine the severity of the hammer toe condition and its underlying cause and recommend options to alleviate pain or difficulties in movement. They typically:

Asses the issues with movement and overall pain associated with hammer toe by reviewing how the foot rotates and moves during typical walking and weight bearing activities
Examine the joints via x-ray to determine how the joints may be affected in their movement and to determine if bone problems are the result of the hammer toe condition or possibly something else
Review the change in condition over multiple visits to see if the condition is growing in severity
Conduct blood tests or arthrocentesis (removal of fluid from a joint to test for problems such as gout, rheumatoid arthritis, or joint infection) to ensure that no other conditions may be the cause of the issue

Surgical Treatments[edit]

Resection - Removal and reshaping of bone from the PIP (proximal interphalangeal) joint. As the PIP joint is often the main culprit of hammertoes, this procedure allows the surgeon to remove the rigid bony build up at the PIP joint that prevented the toe from straightening.

Arthrodesis - Fusion of the PIP joint to minimize motion and pain. To prevent the PIP joint from returning to its crooked appearance, the PIP joint is often positioned so that bone will fill the joint. This permanently restricts the hammertoe from reappearing, and eases pain associated with the deformity. Toes are unique, in that it can be fused with minimal impact to everyday activities, unlike other joints like knees, shoulders and fingers; there may not be any noticeable difference in function, compared with the other normal toes.

Tendon transfer - The tendon that flexes the toe is re-routed from under the toe to the top, so that it pulls the toe down into proper alignment. The bend at the PIP joint in the hammertoe is often caused by an unbalanced tendon that has begun pulling the toe in an unnatural position. Over time, this unbalanced state may become permanent, and the surgeon move the tendon into a more balanced position through a tendon transfer.

Tendon lengthening/capsule release - The tendons that pull the toe up and/or down may be partially cut to relax and straighten the toe. When surgery is required, the tissue around the hammertoe has begun to act as if the deformed position is normal, creating a very rigid and painful toe. To restore alignment and ease the tension on the PIP joint, this tissue may need to be trimmed through minor cuts of the capsule that surrounds the joint.

Metatarsal shortening - A portion of the long bone near the base of the toe is removed, giving the toe more space to extend itself. Most shoe manufacturers design their shoes to accommodate a "normal” waterfall appearance of the toes, with the big toe being the longest, and each smaller toe being slightly shorter. However, not all toes match this appearance: hammertoes are often created when a toe that is naturally longer than the surrounding toes is shoved into a shoe with a restrictive toe box, causing it to buckle. Over time, this longer toe permanently maintains this crooked appearance, becoming a rigid and painful hammertoe. Metatarsal shortening corrects this underlying cause of hammertoes by shortening the problematic longer toe, thereby allowing the foot to better accommodate footwear.

Surgical Device Options[edit]

There are several surgical products available, K-wire, or wire pin treatments: After the toe us straightened by surgery, it is fixed in position t with a wire placed through the bone and out the tip of the toe. The wire remains in while the bone fused and the tissue healed. After several weeks, the wire is removed at the surgeons' office. The wires are typically exposed out the end of the toe for several weeks which limits activities and requires special shoes. There are also possible issues of breakage and dislodgement of the wires. While this treatment can be permanent, patients have experienced their hammertoes returning.

Implants: Recent options for hammertoe include surgical implants. These implants stay in the toes and unlike the k-wire, there is no need for a return visit to the doctor for removal. The surgery requires one recovery period and there are no protruding elements that need to be accounted for, allowing for the wearing of normal footwear quickly after surgery, depending on the needs of the patient.

References[edit]

Wright Medical Technology, Inc., MiToe™ - www.mitoe.com*

This article "Hammer Toe Orthopedic Surgery" is from Wikipedia. The list of its authors can be seen in its historical and/or the page Edithistory:Hammer Toe Orthopedic Surgery. Articles copied from Draft Namespace on Wikipedia could be seen on the Draft Namespace of Wikipedia and not main one.