Surgical Correction of Hallux Hammertoe

What is hallux hammertoe?

Hammertoes of the lesser digits can be a common occurrence but the big toe can also develop a hammered deformity. Our big toe is one of the most important structures that allows us to walk and run. Without it we are not able to push off of the ground effectively and therefore decrease the efficiency of out gait. Hallux hammertoe is when the joint of the great toe contracts and creates a deformity. This can cause problems because the joint can be painful, the top of the toe can rub on the inside of the shoe, and the gait cycle will be affected in a negative way.

How do we get a hallux hammertoe?

Causes include but are not limited to familial disease, stroke, muscular dystrophy, poor foot biomechanics, and trauma. The most common cause of this deformity is poor foot biomechanics. What this means is that the improper foot structure causes strain to the foot, which leads to the toes contracting to compensate for the poor biomechanics. Simply put if the arch collapses too much it will result in the contracture of the toes. Trauma can cause this deformity by changing the structure of the joint which could lead to muscle imbalance and arthritis. These changes typically result in a rigid contracted deformity of the great toe.

What are the symptoms of a hallux hammertoe?

The hallux can be in a flexible deformity or a rigid deformity. The flexible contracture can be less symptomatic but both can cause severe symptoms. The typical complaint is pain at the tip and the top of the great toe. The tip of the toe hurts because the great toe is contracted down and the tip of the toe is being pounded into the ground at every step. The top of the great toe can also be painful because it may be rubbing against the top of the shoe. The pain can also be within the joint of the great toe. This is because the rigid contracture can be a result of arthritis and therefore no cartilage is present in the great to to allow for smooth movement. Pain and swelling can be a common symptom especially towards the end of the day.

How do we diagnose hallux hammertoe?

The doctor will perform a full physical exam of the patient and first determine whether the deformity is flexible or rigid. Once this is determined X-ray filmography may be utilized to check for any trauma, arthritic bone, and also view the overall structure of the foot. An MRI can be utilized if there is a suspicion for soft tissue trauma.

How do we treat hallux hammertoe?

A soft tissue release of the tendons may be beneficial to the patient if they suffer a flexible deformity. The flexible deformity can occur secondary to muscle spasm of the flexor and extensor tendons. By releasing the tendon that is tight the deformity will be decreased. This procedure can be done under local anesthetic and can be performed in the office.

If the deformity is rigid then boney fusion may be necessary. The big toe joint is made up of two smaller bones called phalanges. The big toe joint can be painful when forced to move. Therefore completely eliminating the movement of the toe by fusing the joint will eliminate the symptoms. Fusion takes about six weeks of healing time and will possibly require a boot to be worn during this time.

 

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