Hammer and claw toe deformities: TOP 10 correctors for treatment

What is a hammertoe?

A condition in which the finger becomes deformed, resembling the shape of a hammer.
Any finger except the thumb can become deformed into a classic hammertoe. There is a true hammertoe deformity, and there is a deformity caused by constant pressure in the shoe. Let's consider true deformation using the example of the 2nd toe.

Rice. 1

• When transverse flatfoot progresses, the 2nd metatarsal bone moves down, and the proximal phalanx is forced to rise due to the traction of the ligaments and tendons (Fig. 1). In this case, the area of ​​the proximal interphalangeal joint rubs in the shoes and a characteristic callus is formed.

Rice. 2

• If the second toe is longer than the first, then in the shoe it begins to rest against the toe and it is forced to bend (Fig. 2). At first we don’t feel this until a painful core callus forms, which can only be removed with a scalpel or surgical laser. This deformation is elastic and decreases when changing shoes over a period of 6 months. But there are patients who resort to shortening the 2nd toe in order to be able to wear dress shoes.

Diagnostics, methods of examining patients

An experienced orthopedic doctor can already determine the presence of the disease by visually examining the patient. The foot is examined for the presence of calluses and calluses.

X-rays are taken to determine the location of the joints, as well as the presence of dislocations.

Symptoms of hammertoe deformity

Patients with hammertoe deformity may experience pain in the forefoot and dorsum of the toe at the proximal interphalangeal joint. Excessive pressure from shoes on a deformed toe or toes can lead to the formation of a callus. Some people can't admit they have hammer toes, thinking it's because of tight shoes. The pain is often aggravated by tight dress shoes, especially high-heeled shoes that our women love to wear.

Causes of Hammer Toe

• Heredity and hallux valgus deformity (bunion on the foot);
• Wearing tight, narrow shoes is the most likely cause of the development of hammertoe deformity;
• High heels can also cause deformity.

I would like to clarify that the hammer-like deformity develops over a long period of time, from a year or more. Some patients with Greek foot type may develop hammertoe deformity due to the predominance of the length of the 2nd toe over the others.

When to see a doctor?

The most common causes of hammertoes for which patients seek treatment are:

• Painful finger calluses
• Lameness when walking
• Difficulty in choosing shoes
• Aesthetically unsightly finger

Hammer toes vary in severity, from mild to severe. May be present in association with a bunion and is almost always present with severe foot deformity.

Depending on the general health, symptoms and severity of the deformity, treatment may be conservative or surgical.

The hammer toe is a flexed phalanx at the first metatarsophalangeal joint. This deformity can develop on all toes except the big toe and is an aesthetic problem that also causes enormous discomfort in the foot. Calluses and other bulges may appear at the location, causing pain when walking.

Hammer toes can be fixed, where you can manually rotate the toe, or unfixed, requiring only medical intervention.

Most often, hammertoe deformity of the second toe occurs; sometimes all the hands become curled, and the entire foot is damaged. In isolation, the anomaly is very rare, and its occurrence may be due to excess length of the metatarsal bone. As the disease progresses, it becomes more and more difficult to walk, the toes rest on the shoes, rub, and painful corns and calluses appear.

The following diseases can cause the development of the disease:

• psoriasis;
• atherosclerosis;
• rheumatoid arthritis;
• diabetes;
• obesity;
• as well as constant wearing of high-heeled shoes.

Treatment of hammertoe deformity of the second toe

After a diagnosis of hammertoe deformity is made, conservative treatment without surgery is prescribed, which includes wearing comfortable and soft shoes, without heels and various insteps.

Boots should not restrict the foot; be sure to have a spacious toe box and a comfortable back part. Orthopedic insoles are recommended.

During this period, courses of therapeutic supervised massage and gymnastics are prescribed, which can be done at home, using non-traditional methods of treatment: herbal baths, rinses, to reduce leg pain.

In the place of greatest friction, patches and cotton swabs should be used; any wounds or injuries should be immediately treated and bandaged.

Also on sale today are toe separators that reduce the risk of contact of the phalanges.

When a hammertoe makes it difficult to move, surgery is prescribed.
The most gentle technique is used, which is used in the initial stages of the disease, when the joints are still being corrected. During surgery, the flexion reflex can be completely eliminated by removing the main phalanx of the dislocated finger. After this, the brush is cast for a month. Radical surgery involves the formation of a transverse arch of the foot, where ligaments, bones and tendons are involved. After such a procedure, a long rehabilitation period is required. This operation is performed under conduction or spinal anesthesia. General anesthesia is rarely prescribed, according to the patient’s individual indications. The duration of the surgical stage is 15-30 minutes. To the section “Treatment of foot deformities”

Conservative treatment of hammertoe

Non-surgical treatments for hammertoes aim to reduce symptoms (such as pain and/or calluses) and/or limit progression to a more severe deformity.

• Wear supportive shoes
• Use insoles with arch supports
• Wear shoes with wide toes
• Silicone correctors and toe pads: protect fingers from friction in shoes and the formation of calluses.

You can also eliminate pain symptoms with medications and ointments:

• Anti-inflammatory drugs: nimesil, ibuprofen, ketonal to reduce pain and inflammation.
• Physical therapy: Strengthen the foot muscles to maintain the longitudinal and transverse arches, minimizing the risk of deformation.
• Corticosteroid Injections: Injections of hormonal anti-inflammatory drugs are powerful to reduce pain, inflammation and swelling directly in the area of ​​the deformed joint.

Surgery for hammertoes

Hammer toes can be corrected with surgery. Moreover, severe and moderate deformities can only be eliminated through surgery. By and large, eliminating the deformation is not difficult.

The operation is performed under conduction or local anesthesia. This means that the foot will not feel pain, but the patient may be conscious. If the person being operated on is anxious or afraid of the operation, the anesthesiologist will provide sedation to help the patient relax.

In our practice, we use methods for correcting finger deformities: open and percutaneous (minimally invasive) surgical techniques.

Open techniques through small incisions and minimally invasive through 2 mm skin punctures. Depending on the severity and duration of the deformity, there are several methods.

• If the deformity and callus are formed due to the longer second toe, then simultaneously with the elimination of the deformity, its shortening is performed.
• If the proximal interphalangeal joint is significantly deformed, then there is practically no movement in it. In this case, part of the joint is removed and its arthrodesis (fixed in a straight position for bone fusion). This eliminates finger deformation. In some cases, the finger is fixed with knitting needles or special metal structures.

Installation of wires, titanium alloy screws or bioabsorbable implants is most often used to fix the bone until it heals. The wires are removed approximately 1 month weeks after surgery. Its removal does not cause pain, rather just an unpleasant feeling. The screws are usually removed 6-12 months after surgery. There are titanium intraosseous implants designed specifically for such operations, but there is one disadvantage that they remain in the bone forever.

Considering the impracticality of removing intraosseous titanium implants, materials have been developed that are absorbed into the bone within 2 years. So-called biodegradable screws, pins. More and more operations are being performed with their help. It is very convenient for Paicent that the retainer does not need to be removed, essentially performing a second operation.

Types of foot surgeries

Operations performed for hallux valgus deformity can be divided into minimally invasive and reconstructive. The former are less traumatic, but are effective only for exostoses and initial deformation. Minimally invasive surgical interventions are performed through two or three punctures measuring 3-4 mm.

Scar after intervention.

Reconstructive interventions help to cope with severe hallux valgus deformity, accompanied by changes in the position of the bones of the foot. Such operations are more invasive and involve more trauma. They are performed through a 2-4 cm long incision on the medial surface of the foot. During surgery, the doctor restores the normal position of the metatarsal bones and fixes the first metatarsocuneiform joint in the correct position.

Table 1. Types of operations.

Minimally invasive intervention.

During minimally invasive operations, the surgeon uses micro-instruments that allow complex manipulations of the ligaments and joint capsule. If necessary, he files the bones using micro-mills, which vaguely resemble dental instruments.

Percutaneous treatment method

Through small skin punctures 2mm. A special cutter with side sharpening is introduced and an osteotomy of a certain area of ​​the bone occurs to eliminate the deformity. As a rule, this technique does not use metal structures or fixators, be it knitting needles or screws. The fingers are fixed with an elastic bandage in a given position. This is very convenient for the patient and does not require repeated surgery to remove the fixator. The following video provides an example of such an operation.

In most cases, after surgery, the patient goes home the same day, but sometimes stays for a day. The next day, the first dressing is changed with a doctor, then the patient can change the dressing independently. After 12-14 days, the sutures are removed.

Laser removal of finger callus. Laser surgery is a popular method, however, the laser is used primarily on soft tissue (not bone). Therefore, this method is used in addition to surgical instruments.

Rehabilitation after hammertoe surgery

Recovery from hammertoe surgery typically depends on the method of surgery performed. In all cases, treatment takes about 4-6 weeks in healthy people, and there are no ways to speed up this process to 1-2 weeks, no matter how much one would like it. Patients often return to normal activities and footwear by the 3rd week after surgery, with only a minor degree of deformity. After simple surgery, recovery can be very fast. Factors that can prolong recovery are age, smoking, and non-compliance with recommendations for limiting exercise in the early postoperative period.

Valgus deviation of 1 finger - symptoms and treatment

Treatment of hallux valgus should begin with the selection of comfortable shoes , orthopedic insoles and exercises to strengthen the muscles. Often, standard orthotics do not help stop the deformity and relieve pain, so it is important to use insoles made individually for the patient.

To prevent and treat the disease, the doctor may recommend a valgus hinge splint - a fixator that holds the joint in its normal position. To reduce inflammation and relieve pain, nonsteroidal anti-inflammatory drugs (for example, celecoxib, ketoprofen) are prescribed [12].

Non-surgical treatment may relieve symptoms but will not correct the foot deformity. Therefore, if pain persists, surgery . The search for effective treatment methods began in the 19th century and, according to various authors, there are from 200 to 500 different surgical techniques [13]. However, the problem is still relevant: surgery brings temporary relief, but does not eliminate the cause - weakness of the muscular system of the foot. All existing methods of foot surgery can be divided into two types: on soft tissues and on bones. The decision about which surgical technique is used depends on the degree of deformity, degenerative changes in the joint, and the shape and size of the metatarsal. Surgeries on soft tissues are recommended for mild to moderate lesions. In severe stages of deformation, there is a need to restore bone structures; for this purpose, osteotomy is used (Latin osteotomia - bone dissection).

The generally accepted method of surgical treatment of hallux valgus is the original McBride technique, created in 1928. Later, the method was improved by various authors, which made it possible to reduce the trauma of the operation and improve its results. The McBride procedure involves passing and fixing the adductor pollicis tendon through a hole in the metatarsal bone. This method is a special case of myotenoplasty (muscle and tendon transfer) and refers to operations performed on soft tissues. In some cases, the McBride operation may be supplemented with osteotomy[3][5][13].

Stages of forefoot reconstruction surgery using myotenoplasty:

1. Feet before surgery.

2. Isolation of the tendon of the muscle that abducts the first finger.

3. Removal of the head of the first metatarsal bone (Sade's operation).

4. Creation of a channel for the tendon of the muscle that abducts the first finger.

5. Passage into the canal of the tendon of the muscle that abducts the first finger.

6. Proximal wedge osteotomy.

7. Osteosynthesis (connection) of bone fragments of the first metatarsal bone.

8. Creating a screed.

9. Feet immediately after surgery.

The patient is usually discharged from the hospital less than a week after the operation. The sutures are removed after 12-14 days. After the operation, the patient uses Baruk orthopedic shoes with a wedge-shaped sole for a month to unload the forefoot. It is worn from two to eight weeks, depending on the complexity of the operation.

On average, after two months the patient can wear regular shoes and returns to his normal lifestyle. However, until six months after the operation, it is undesirable to wear shoes with heels more than three centimeters. To prevent relapses, you should wear insoles. Conclusions about the success of the operation can be made after three to four months (in severe cases - after six months) based on control X-ray images.