Corns, calluses, and pain may indicate joint problems.
Many disorders can affect the joints of the toes, causing pain
and preventing the foot from functioning as it should. People of
all ages can have toe problems.
The major culprit of toe deformities in adults is tendon
imbalance. When the natural function of the foot is disrupted the
tendons may stretch or tighten to compensate. Thus, people with
abnormally long toes, flat feet or high arches have a greater
tendency to develop to deformities.
Arthritis that slowly destroys the joint surface is another
major cause of discomfort and deformity. Toe deformities also can
be aggravated by restrictive or ill-fitting footwear worn for a
prolonged amount of time. Or, problems with toe position may occur
if a fractured toe heals in a poor position.
Common Deformities
The most common digital deformities are hammertoes, claw toes,
mallet toes, bone spurs, overlapping and underlapping toes, and
curled toes.
These deformities may or may not be painful. Corns and calluses
- a buildup of skin on the affected joint, often associated with
bursitis (inflammation of small pouches, called bursas, which lie
above the joint between the tendon and skin) - are perhaps the most
noticeable and bothersome symptoms. If deformities are left
untreated, the toe's mobility may become limited, and more serious
problems, such as skin ulceration and infection, may develop.
Hammertoes
A hammertoe may be flexible or rigid, and may occur
on any of the lesser toes. Ligaments and tendons that have
tightened cause the toe's joints to buckle, cocking the toe upward.
Shoes then rub on the prominent portion of the toe, leading to
inflammation or bursitis. Corns and calluses soon form.
During the early stages, a hammertoe remains flexible, meaning
it will straighten when pressure is applied to the buckled area. As
time passes, the toe can become permanently buckled or rigid
requiring surgery for correction. Painful calluses on the bottom of
the foot may accompany rigid hammertoes because of pressure
generated on the joint.
Mallet Toes and Claw Toes
Mallet toes and claw toes are similar in appearance to
hammertoes but joints at different locations on the toe are
affected. The joint at the end of the toe buckles in a mallet toe,
while a claw toe involves abnormal positions of all three joints of
the toe.
Bone Spur
A bone spur is an overgrowth of bone that may occur alone of
along with a hammertoe. Pain, corns and calluses are the major
symptoms. Left untreated a bone spur may eventually be accompanied
by bursitis or small skin ulceration.
Overlapping and Underlapping Toes
Any one of the toes can overlap or underlap, pushing on adjacent
toes and causing irritation. Overlapping or underlapping of the
fifth toe is a common congenital problem that is easily corrected
in children. Bunions can cause the second toe to over lap in
adults. Pain, inflammation and small corns or areas of built up
tissue may result. This deformity also can interfere with the
normal function of the foot, and if left untreated, may lead to
enlargement of bone or bone spur formation.
When the deformity is painful or permanent, surgical correction
is recommended to relieve pain, correct the problem and provide a
stable, functional toe.
Depending on health status, surgery may be conducted on an
outpatient basis at Lourdes.
Tenoplasty and/or capsulotomy
refer, respectively, to the release or lengthening of tightened
tendons and ligaments that have caused the joint to contract. In
some flexible hammertoe cases, the toe straightens out after these
soft tissue structures are lengthened or cut and relaxed. Surgery
relieves pain and improves the toe's mobility.
Tendon Transfer, another treatment for a
flexible hammertoe deformity, involved the repositioning of a
tendon to straighten the toe.
During bone arthroplasty procedures, some bone
and cartilage is removed to correct the deformity. A small portion
of bone is removed at the joint, eliminating pressure on the toe,
relieving pain and straightening the digit. The tendons and
ligaments surrounding the joint also may be reconstructed. Multiple
digits can be operated on simultaneously in certain cases.
Derotation arthroplasty is a variation of
arthroplasty used to realign the toe. A small wedge of skin is
removed and the toe is properly positioned. The surgeon also may
remove a small amount of bone, and will repair the toe's tendons
and ligaments.
Implant arthroplasty is similar to arthroplasty
in that a small portion of bone is removed. A silicone rubber or
metal implant specially designed for the toe is inserted to replace
the gliding surfaces of the joint and to act as a joint spacer.
Implant arthroplasty helps maintain toe length while relieving
pain, and realigning and stabilizing the joint. Implants may be
recommended when previous surgery has left the toe improperly
positioned without skeletal support.
Fusion of the toe is most often used to correct
toe fractures or, like implant arthroplasty, to increase the
stability of the toe after arthroplasty. After the bone ends are
removed, they are positioned together and compressed so that the
bones unite. Fusions may be stabilized with a stainless steel pin
as the bone heals. Care must be taken to avoid any impact that
would damage or break the pin after surgery. Pins typically remain
in place for approximately five to eight weeks.
Some swelling, stiffness and limited mobility can be expected
following surgery, sometimes for as long as eight to twelve
weeks.
While these are some of the most commonly prescribed treatments
for digital disorders, others may be used. The podiatric surgeon
will determine which treatment is likely to be the most successful
in each case.
Ask your physician about surgical
procedures to correct digital disorders at Lourdes.
