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2015.07.09
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カテゴリ:カテゴリ未分類

Overview
A Hammertoe is a toe that tends to remain bent at the middle joint in a claw-like position. There are 2 types of hammer toe. Flexible hammer toe, can be straightened by hand. Rigid hammer toe, cannot be pulled straight and can be extremely painful. The position of the toe can also lead to corns or calluses. These may also be painful. Hammer toe may be present at birth or develop later in life due to tendons that have tightened, causing the toe's joints to curl downward. Occasionally, all toes may be bent. This may be due to problems with the peripheral nerves or the spinal cord.

Causes
Hammer toe results from shoes that don?t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Some other causes are diabetes, arthritis, neuromuscular disease, polio or trauma.

Symptoms
The most obvious symptom of hammer, claw or mallet toe is the abnormal toe position. This is usually combined with pain: the abnormal foot position leads to excessive friction on the toe as it rubs against any footwear which can be extremely painful. Corns & Calluses: repeated friction can result in the formation of a foot corn or callus on top of the toes. Stiffness, the joints become increasingly stiff. In the early stages, the toes can usually be straightened out passively using your hands, but if allowed to progress, the stiffness may be permanent.

Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment
Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area. Wear a shoe with a deep toe box. If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid heels more than two inches tall. A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist's office will be necessary to repair the toe to allow for normal foot function. Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.

Surgical Treatment
Sometimes surgery can not be avoided. If needed, the surgery chosen is decided by whether we are dealing with a flexible or rigid hammer toe. If the surgery is on a flexible hammer toe, it is performed on soft tissue structures like the tendon and or capsule of the flexor hammer toe. Rigid hammer toes need bone surgeries into the joint of the toe to repair it. This bone surgery is called an arthroplasty.






最終更新日  2015.07.09 14:41:50
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