If you are a woman who loves to wear high heels, especially those with pointed toes, then you must read this. Take off your shoes and look at your toes. You may notice your toes bending with corns and calluses or pale or darker spots on the toes. If you have to grin and bear it when wearing your favorite high heels but can't wait to take them off, because your little toe is "killing" you, you may have hammertoes.

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

Hammertoes usually start out with a little bending and get worse over time. In the early stages, hammertoes are flexible, and the toe can be straightened out to its original shape. But, if left untreated, hammertoes can become stiff or rigid and will stay in the bent position permanently. Hammertoes seldom get better without some help. Because hammertoes tend to get worse over time, they should be treated early.
Causes

Hammertoes are caused by an imbalance in the muscle and tendon around the toe. Because of the way some people walk, mechanical (structural) changes can occur in the foot leading to this imbalance and bending of the toe. Hammertoes are often made worse by shoes that don't fit properly or are too high. They may also result if a long second toe is forced into a cramped position when a tight shoe is worn. In some people, hammertoes run in families and occasionally, they can develop from injury to the toe.

Symptoms

Common symptoms of hammertoes include:

o Pain or irritation to the toe when wearing shoes -- especially high-heeled, tight or pointed toe shoes.

o The skin on the tops of the toes may be darker or lighter than the rest of the toe.

o Corns and calluses (a buildup of thick skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction on the feet against the shoe.

They may be soft or hard, depending upon their location.

o Inflammation, redness, pain or a burning sensation on the toe.

o Contracture (permanent bending) of the toe.

o In more severe cases of hammertoe, open sores may form.

Diagnosis

To diagnose a hammertoe, the podiatrist will obtain a history of your symptoms and examine your foot. During the physical exam, the podiatrist may try to straighten your toes, and x-rays of the foot will be taken to find out how bad the toe is deformed.

Hammertoes will not go away by themselves and will usually get worse over time. Some progress quickly while others take a longer time.
Conservative treatment

There is a variety of treatment options for hammertoe. The podiatrist will choose a treatment based on the severity of your hammertoe and how it is impacting your feet and life. These may include any or all of the following:

Padding corns and calluses: Your podiatrist can provide or prescribe pads designed to take the pressure off and protect corns from irritation. There are also over-the-counter pads that can be used, however avoid the medicated types. Medicated pads are generally not recommended because they contain a small amount of acid that can be harmful. They can cause the color to change on the toe (darker or lighter) and may cause ulcers/sores to the toes. This is especially true for people with diabetes. They must never use medicated corn pads.

Changes in shoes: Avoid shoes with pointed toes, shoes that are too short or shoes with high heels. All these conditions can force the toe against the front of the shoe and encourage or aggravate hammertoes. Instead, wear comfortable shoes with a deep, roomy front and heels no higher than two inches.

Orthotic devices: A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance and prevent or delay the hammertoes.

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

Medications: Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation in the toe.

Splinting/strapping: Splints or small straps may be applied by the podiatrist to realign and straighten the bent toe.

Surgery: In some cases, when the hammertoe has become more rigid and painful, when the conservative treatment has not helped or when an open sore has developed, surgery is needed to treat the hammertoe.

The podiatrist will choose the best procedure to fix your hammertoes based on how bad they are, the number of toes involved, your age, your activity level and your general health. Surgery can be performed to fix one or more hammertoes. The time to heal after surgery depends on the procedure(s) performed but can be between three to six weeks.

o For more information or to see a podiatrist, visit Bahamas Foot Centre Rosetta Street, telephone 325-2996; Bahamas Surgical Associates, Albury Lane, telephone 394-5820; or email us at foothealth242@gmail.com, or visit www.apma.org.

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