Dec. 10, 2014 11:07 a.m.
Everyone expects our female celebrities to be perfect from head to toe, but we all know that is not always the case. Every once in a while, we get a glimpse of celebrities like Paris Hilton, Kate Hudson, Oprah and Kim Kardashian posing in high heel stilettos or open-toe shoes for a red carpet photo shoot or a magazine cover. These photos and stories reveal that many of our celebrities have the same type of foot problems that millions of American women are suffering from — swollen ankles, miserable bunions, crooked toes and nasty hammertoes.
Hammertoes are one of the most common foot deformities among my female patients. They occur most often in women who wear high heels or in narrow shoes that cause the unnatural bending in the middle joint of the toe. In the U.S., women constitute more than 80 percent of the cases and this condition is most prevalent between ages of 50 and 70. It is estimated that more than 500,000 hammertoe surgeries are performed each year.
Many of my female patients who have been muddling through life with severe pain caused by hammertoes and reluctantly stopped doing physical activities they once loved. Any physical activity that requires a bit more walking or standing, like shopping in the mall or taking a recreational walk becomes difficult without another layer of padding to their shoes. Playing tennis or running is even more challenging and unfortunately many of them have decided to “just call it quits.” Many of them have already tried conservative treatments like changes in footwear, pads, cushions and physical therapy, but nothing seems to work. The problems of hammertoes for many women go well beyond their wardrobe.
When I ask them what took them so long to seek treatment, the overriding response is that they were too busy to take time off for surgery. Many of them are also scared to death of surgery because of the horror stories they have heard and just decide to tolerate the pain. Many women however, are seriously ready to explore surgical options. Here are some of the common issues we talk about:
What are some of the non-surgical treatments that I can try?
Non-surgical treatments cannot correct a hammertoe deformity. The goal of non-surgical treatments is to prevent the progression from advancing and to eliminate pain. Here are some ideas:
* Wear comfortable shoes with soft upper materials that provide more room in the toe box around the hammertoes. Open-toe shoes can also relieve pressure and provide pain relief.
* Visit a shoe repair shop to have your shoes stretched in the toe box so it bulges out around the hammertoe.
* Each week, trim or file down your calluses and corns with a pumice stone following a bath or shower.
* Apply silicone pads, toe sleeves and splints that are available at local drug stores are also helpful. Over-the-counter foot inserts and custom orthotics help reduce hammertoe pain that is associated with pain at the bottom of the ball of the foot or under the big toe. Consult with your doctor about self-help exercises that can be done in your home. Try doing simple calf stretching exercises done on each leg for 30 to 60 seconds twice a day to stretch the Achilles tendon and calf muscle.
When is surgery an option?
Surgery becomes a viable option if the conservative treatments do not improve your symptoms or alleviate the pain. Unfortunately, there is no guarantee that your toes will completely return to their normal position after surgery, and the joint problems may return. If the deformity is the result of a nervous system problem or a condition that affects your blood vessels, surgery may not even be an option.
What kinds of surgery are available?
Surgery is generally a last resort measure that is used to correct the deformity and relieve the pain. There is no single surgical procedure that is best for everyone because each patient is different. After conducting a thorough assessment of the underlying causes, your surgeon will know when surgery is the best option for you. Multiple surgical procedures are available, and each one accomplishes a slightly different outcome. Your surgeon may have to mix and match procedures to tailor the best treatment for you.
Usually surgery is done on an outpatient basis with a local anesthetic and you are allowed to go home the same day. Most of the time you are permitted to walk after surgery and you are not put in a cast; however, this may not be the case if other more extensive procedures are required to correct your foot.
Surgical correction usually involves the rebalancing of tendons and ligaments where the toe joins the ball of the foot and straightening the middle of the toe joint by fusion. Sometimes other surgical procedures are done to correct associated deformities like bunions, or to loosen the calf muscle. Some of the types of surgeries include:
* Resection – removal of bony build parts of the toe joint that prevents the toes from straightening.
* Tendon transfer, lengthening, or release — re-routing the tendon to put it in a more balanced position, relaxing the tendon so the toe can be straightened, or restoring the alignment to ease the tension in the joint.
* Metatarsal shortening – shortening the long bone to provide more space for the toe to extend into footwear.
* Arthrodesis — removal of part of the joint letting the toe bones grow together to minimize motion and pain.
Several of these procedures require the implantation of orthopedic products to fix the deformity and to neutralize the soft tissue imbalances that contribute to the deformity. These products may include wire pins, screws and implants to ensure joint fixation and stabilization. Newer bone fixation methods that have been introduced include allograft bone pins, bone staples, resorbable rods, one- and two-piece metallic fixation devices, and intramedullary K-wires.
How long is recovery?
Recovery varies depending on the type of surgery performed. In minor instances that require a release or lengthening of the tendon, surgery is simple and quick, and recovery time is a minimal. In moderate cases that use permanent implants, recovery is fairly simple because there are no wires protruding out the ends of the toes. Healing occurs over a few weeks with full recovery within a month or two. In more advanced cases that use wire pins and screws, or involve procedures to correct other deformities, pins are left in place for 6 weeks and removed in the clinic. It may take 4 to 6 months to fully recover. For the more extensive surgery, patients who have a sedentary job can return to work quickly in 2 weeks and within 2 months if their job requires standing or walking.
What are the success rates for hammertoe surgery?
The success rate for hammertoe surgery is estimated at approximately 85 to 90 percent; however, it is difficult to predict the results of hammertoe surgery because there is such a wide variety of deformities and surgical variables. The standard wire pins technology that has been widely used for the past 30 years continues to be the predominant method of choice; however, many new internal fixation and decompression techniques are producing wonderful outcomes. Success largely depends on selecting a skilled surgeon who is able to successfully perform the exact procedure required, whether it is a resection, an arthrodesis (toe joint fusion), an arthroplasty (joint replacement), a metatarsal shortening (making an adjustment to the length of the toe), or balancing the soft tissue that positions the toe. The ultimate success is achieved if your surgeon is able to correct your deformity and relieve your pain.
What are the risks?
As with any surgical procedure, there are risks associated with hammertoe surgery that a patient should discuss with their surgeon. Consult with your surgeon to understand the pros and cons of all non-surgical and surgical treatment options.
Don’t let hammertoes cramp your style. If you are interested in seeking a board certified surgeon for information about hammertoe treatment or surgery, call Dr. John M. Sigle at (217) 787-2700 for an appointment. Also visit the Foot & Ankle Center of Illinois website library at myfootandanklecenter.com.