Hammertoe

Hammerzeh: description

In a hammertoe (Hallux malleus, Digitus malleus), the toe center joint is bent so high that the end member points to the ground like a hammer. There is also a rarer form of this deformity, in which only the final limb is affected: the end joint hammer toe (Malletzehe). In her, the end joint is so strongly curved that the toe tip touches the ground.

Most people affected by hammertoes also have foot deformities such as splayfoot, hollow foot or ball toe (hallux valgus). Rarely is a hammer toe innate.

Even minor deformities can cause pain. If the hammer toe is pronounced, those affected will often find no more suitable shoes. Especially with this disease, a good footwear is indispensable. With a slight misalignment, well-fitting shoes can often improve the symptoms. Alternatively, a hammer toe operation is possible, in which there are various surgical techniques.

Hammerzeh: symptoms

A hammer toe does not necessarily lead to discomfort. Mostly people only go to the doctor if they are in pain. Others suffer from their foot shape being visually altered by the hammer toe. If the disease progresses, those affected no longer find any shoes that suit them well. If the shoes are pressed, horny calluses, such as corns on the toes or underneath the ball of the foot, can also increase in a hammer toe. Partially, these splinters cause severe pain.

For all the symptoms described, it should be noted that they need not be related to the degree of malposition. Even a slight hammer toe can cause severe discomfort, while other people feel no symptoms, even with pronounced hammer toes.

Hammerzeh: causes and risk factors

Most hammertoes occur in the course of life. There are certain risk factors that favor this malposition:

Inappropriate footwear:

Especially too small or too narrow shoes can cause the toes to be compressed. In the long run, the foot muscles are weakened and can control the position of the toes less and less. At first, the toe can be bent well up and down by hand. But if the toes are caught in unfavorable shoes for a long time, the deformation remains firm.

Accompanying foot deformity:

A splayfoot or hollow foot changes the arch of the foot. If the foot is over- or misaligned in one of these misalignments due to overweight or unsuitable shoes, the forefoot loses its tension. The longitudinal vault sinks, and the toes diverge. This changes the pulling direction of the muscles and tendons. The toes are bent like a hammer.

Even with a ball toe (hallux valgus) hammer toe can arise. Sometimes the big toe deviates so much from the outside that it slides under the other toes or displaces them.

Neurological disorders:

Spastic paralysis sometimes causes muscle cramps (contractures) on the feet, which can lead to a hammer toe. Also with other neurological illnesses like the Friedreich Ataxie arise more frequently hammer toes. This is because sufferers often also suffer from a hollow foot, which represents a risk for a hammer toe.

After trauma:

A trauma (such as an accident) can result in a so-called compartment syndrome – a massive, circumscribed pressure increase in the tissue, which can affect the blood circulation and disrupt the function of muscles and nerves. As a result, a hammer toe can arise.

Rheumatism:

Rheumatoid arthritis is a chronic arthritis. It can also occur in the toe joints and favor a hammer toe.

A hammer toe is congenital in rare cases. Then it occurs even in toddlers who can not even walk and do not wear constricting shoes. These children are usually affected by both feet, preferably the second toe. Initially, the toe tip is slightly bent down. In the first years of life it is still possible to flexibly move the affected toe. But if you do not treat the hammer toe, the toe joints can stiffen. It forms a typical hammer toe.

Hammerzeh: examinations and diagnosis

A hammer toe usually recognizes a doctor when he looks at his foot. This diagnosis is supported when the patient reports the typical symptoms.

The doctor checks if the toe can still move. This allows him to distinguish whether it is a stiff (contract) or flexible (flexible) form of hammer toe. In a flexible malposition, the doctor can compensate for the curvature when he pushes from the sole of the foot against the toe joint (push-up test). With a stiff misalignment this does not work. The distinction between a stiff and a movable hammer toe is important for a correct treatment.

Sometimes X-rays of the foot are made. Above all, they serve to plan a hammer toe operation.

Hammerzeh: treatment

With a hammer toe you should definitely pay attention to a suitable footwear. The shoes should be neither too small nor too narrow. If pain still occurs, you should consult a doctor. Depending on how pronounced the malposition is, the doctor can choose between different treatment alternatives:

If there are only slight bruises, the shoes can be individually adjusted. One way, for example, is to widen the shoe cap so that the toes have more space in the shoe again. Another option is felt rings, which are stuck in the shoes. They distribute the pressure and reduce pressure points. Orthopedic shoe inserts can usually prevent further pressure damage, and the disease progresses.

In many cases, however, only a hammer toe operation helps. The surgeon can choose one of the following surgical methods. The decisive factor is how much the toe is curved and whether it can still be moved.

Tendon transfer:

This hammer toe operation is an option if it is still a flexible malposition. The surgeon displaces the extensor tendons of the affected foot muscles. Mostly he also extends the flexor tendons. The tendons can not pull so much on the bone after surgery. The toe is thereby relieved, and bruises are formed back.

Joint reconstruction:

If the toe bones are more deformed, the surgeon removes a piece of the middle or base member. Then he straightens his toe. Sometimes a small wire is inserted into the hammer toe. He should stabilize the toe in the corrected position and can be removed after a few weeks.

Hammerzeh: Disease course and prognosis

A hammer toe does not disappear on its own. Mostly the misalignment worsens over time. That’s why he should be treated as soon as possible. If the disease is still at an early stage, it may even be one HammertoeOperation are avoided.