Even though feet are like snowflakes, no two are the same; that lump or bump at the base of the your big toe and curling toes are getting painful. Surgery does not fit into your plans with all the demands on you right now. Maybe your busy schedule has you traveling where you pick up a magazine and notice the toe separator sock toting all the benefits of wearing this $20 sock that will straighten your hammertoes and bunion forever. Seriously?!
I want everyone who reads this to memorize this next sentence. I am here to make your feet better! If a $20 sock would alleviate bunions and hammertoes, don’t you think that everyone in the world would use these? I don’t want to take someone to surgery who can be fixed by wearing a sock to sleep. Let’s face the facts, bunions and hammertoes are deformities. There is an alignment problem with your bones. Stretching the muscles will not change how your bones are lining up.
Reviewing the options for hammertoes and bunions other than surgery:
- changing your shoe style to avoid pressure on the painful area
- padding your painful bunion or hammertoe so that it doesn’t rub on your shoe
- anti-inflammatory medicine such as ibuprofen to relieve pain as needed
That’s all the options. Notice that there is no splinting option because splinting doesn’t work. I really wish it did, but it doesn’t.
If you have painful bunions and hammertoes and want to get a real opinion what can be done, come to Desert Foot Surgeons. We fix feet!
Cosmetic foot surgery most often involves hiding the scar. When surgically straightening a hammertoe, it is easiest to place the incision on the top of the toe. This leaves the scar in an area where you can see it every day. Worse yet, if you are one of those people who does not scar well, other people can see the scar. In these photos you can see before and after surgery. What do you notice besides the pink toenails instead of the french pedicure? Surgery was performed on the 2nd and 4th toes. Remember to begin counting with the big toe as number 1. The 2nd toe is still a little bit swollen since this is only 6 weeks after surgery, but it is shorter and the “bumpy” appearance and pain are gone. If you notice the 4th toe before and after, look at the toenail. You can tell the toe is less turned after surgery because you can see more of the toenail. What you can’t see are the scars.
You may be a candidate for cosmetic foot surgery to correct your hammertoes.
What’s the first thing that came to mind when you saw the word “cosmetic” in the title? Was it maybe breast implants or a face lift, tummy tuck or liposuction? These are the traditional uses of the word cosmetic and refer to correcting problems in people, who in their opinion, need to look better in order to feel better. Over the years it has become popular for people who can afford to undergo these same surgeries to enlarge their breasts, tighten the skin of their face to reduce wrinkles, and even remove fat from areas considered to be unsightly.
In the foot people can have unsightly problems and what’s worse pain. A bunion is a lump on the inside of the foot behind the big toe. The size can vary and the toe can begin to move closer to and even under the 2nd toe. When the smaller toes are buckled that is a hammertoe. Here’s the key: because we wear shoes, bunions and hammertoes hurt much sooner than if we went barefoot all the time. Let me make this perfectly clear, wearing shoes does not cause the deformity, but wearing shoes does make a deformity hurt sooner than it otherwise would.
Bunion and hammertoe surgery can be cosmetic, which in my opinion means the deformity will look better after corrected so that you feel better since pain will be gone. That’s a little bit different from other forms of cosmetic surgery. When I perform bunion surgery or hammertoe surgery I always keep in mind the fact that you will be walking on the end result for years to come. Because the bunion and hammertoe develop in an unstable foot I have to make sure the problem does not return. Face lifts, tummy tucks, or breast augmentation have their long term considerations, but honestly you will not be walking, hiking, or running on these parts of your body.
There are people who want to fit into those 4” spiked heels at any cost. They want their wide foot narrowed and long toe shortened. I’m not talking about business executives who have to maintain a specific style of dress in order to advance their career and suffer horrible pain in these shoes. I’m talking about people who would otherwise have no pain, but insist on wearing these heels for social purposes. I caution those people who do not have pain! Foot surgery can result in scar within the joint leading to stiffness and arthritis. There is no true preventive surgery for arthritis.
One final word. Recently a Beverly Hills Podiatrist coined the term “Cinderella Surgery” for correcting a bunion, long 2nd toe, and bunionette (on the outside of the foot) so that women can wear their high heels. He did a very nice piece on the television show, The Doctors. My problem is this: I always say, feet are like snowflakes no two are alike, well here is a podiatrist telling women he can perform the same procedures on their feet in every case so they can walk immediately after surgery and their feet will fit into their stilettos. That is just not possible without making some sacrifices. To read about these sacrifices that might be made check back every few days for my new articles on cosmetic bunion surgery and cosmetic hammertoe surgery.
A hammertoe is when your toe buckles or bends as a result of an unstable foot. This can range from a mild twisting of the toe to such a severe buckling that the toe sits on the top of your foot. Dress shoes for women and men are not made with ample room for the toes. When a toe is buckled there is pressure and rubbing of the toe against the shoe leading to pain, redness, and formation of hard skin known as corns and calluses.
Hammertoe surgery has been described in a previous article where I talked about the difference between correcting the 2nd and 3rd toes vs. the 4th and 5th. To review the 2nd and 3rd toes usually involve toe fusion surgery, while the 4th and 5th involve toe joint surgery where the joint is removed. Muscles and tendons are often rebalanced around the base of the toe and sometimes work further back in the metatarsal is needed. Cosmetic surgery on a hammertoe can mean hiding the scar or just the fact that I will make your toe look better.
Many people have one toe longer than the others and consider this unsightly. Mind you this toe is not buckled and not painful, but some people want this toe shortened. A doctor might decide to remove some bone from the toe shortening this long toe and performing toe fusion surgery thinking he is making the toe stable. Unfortunately there are tendons in each and every toe that are not shortened with the toe because tendons don’t heal well. Tendons rely on being a specific length, for geeks like me that would be 125% of the muscle/tendon resting length, in order to work. So yes I can shorten your toe and in turn I have just made your toe unstable. I might have performed toe fusion surgery to make that toe joint stable, but the other joints are not, so your toe buckles and now you have a toe sticking straight up in the air. Would that be worth it to you? As the podiatrist who spends a great deal of time fixing poor surgical outcomes, I can tell you it is much more difficult for me to correct this problem.
What exactly do I mean by hiding your scar? Most hammertoe surgery is done through the top of the toe. This is beneficial if I have to address the tendons, ligaments, joint capsule, and even bone at the base of the toe or metatarsal. If your toe can be treated just by toe joint surgery alone than I can make the incision on the side of your toe so that no one will ever see your scar. The sacrifice I am making to use this incision is that I cannot rebalance the joint in the ball of your foot. If your toe is buckled and you have pain in the ball of your foot do not expect a scar any where other than the top of your toe.
Cosmetic hammertoe surgery means making your toe look better and relieving pain. I have talked about some of the risks and sacrifices that are involved in making this decision. Remember what I always say, feet are like snowflakes, no two are alike. Your surgery will be different from your friends and it should be. Don’t forget to read the articles on toe surgery without the pin and recovery from hammertoe surgery.
So you’re at the point where you need surgery to fix your hammertoes and you want more information. They way I fix your toe depends on the cause and there are 3 causes of hammertoes. These different causes make the toes bend and twist in different directions. Your 2nd and 3rd toes will bend in a straight line, but your 4th and 5th toes twist as they bend so the nail doesn’t sit on top of the toe any more. Just to clarify, your little toe is #5 and your big toe is #1. Counting from your big toe to the little toe goes 1, 2, 3, 4, and 5.
Let’s start with your 4th and 5th toes. Unfortunately shoes press the hardest on your 4th and 5th toes. Because of this constant pressure I can’t make these toes stiff or you would never wear shoes again without pain. In fact, your 4th and 5th toes are fixed by removing the crooked joint and leaving the toe flexible. Removing the joint will fix the bend, but does nothing to fix the twisting so I have to use a carefully planned skin incision to un-twist your toe and bring the nail back on top. The bandages will help to hold your toe in this position since there are no screws or pins, so it is very important that you do not remove your bandages. To prevent the tendons from pulling on your toe you must wear a special shoe or boot. You will be allowed to walk after the surgery as long as you wear this shoe or boot, but remember that the more time you spend walking around on your foot after surgery the worse the swelling and pain will be. Stitches are removed after 10 days and you will wear a loose fitting tennis shoe before you return to tighter shoes. I expect swelling to last 3-6 weeks, but a lot of that depends on your body.
Your 2nd and 3rd toes are more complicated to fix than the 4th and 5th because they buckle for a different reason. Because of this difference I have to treat these toes using another approach. Your 2nd and 3rd toes must be made stiff so that the muscles won’t cause the toe to buckle again after it has been fixed by surgery. That means that after the surgery your 2nd and 3rd toes will not bend at the toe joint. You will have a screw or pin in your toe to hold the bones straight. The screw or pin can be removed in the office at a later date if needed. No doubt you have heard stories about people having pins sticking out of their toes after hammertoe surgery. I use newer technology when I can so that you won’t have anything sticking out of your toe. It is still important that you not change the first set of bandages after surgery. In straightening your 2nd and 3rd toes I am removing the crooked joint and making the bone ends heal together. You will be able to walk using special cast boot, but again the amount you walk determines how much swelling and pain you get. The bone takes about 1 month to heal. Tennis shoes are easier to wear at first and as swelling and pain subside you can progress to the shoes you want, within reason.
That’s the scoop on the most common hammertoe surgeries. I’ve told you how fixing your 4th and 5th toes are different from your 2nd and 3rd. You have an idea of what to expect after surgery. I have not told you about the more complex toe problems, but will in future posts. For now remember what I always say, “feet are like snowflakes, no two are alike”. The surgical approach from one foot to another has to be different, that’s the art of surgery and is one of the main things separating me from other foot surgeons you might meet.
Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.
The treatment differs based on the stiffness of the bent toe. Smaller toes such as the 4th or 5th that can be straightened by hand often can be treated by simple tendon release. This is the easiest hammertoe surgery to recovery from often requiring a single stitch. If more than one toe is done at a time the recovery can be slightly longer.
If the bend in the toe cannot be straightened by hand, removal of the rigid joint is performed. At Geller Podiatry we employ a detailed step-wise approach to straighten all parts of the toe. The more deformed the toe, the more steps will be used from simply fusing the toe joint straight to breaking the metatarsal head and repositioning the entire toe. Tight skin has to be lengthened using plastic surgery techniques so that the toe can stay straight and the scar is more cosmetic. In general these procedures require protection from walking using a cast boot. X-rays are used to follow the toe healing process and you will be returned to shoes when your doctor sees evidence of bone healing.
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Hammertoes
Hammertoes
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Hammertoes develop when the toes buckle under the pressure of walking on an unstable foot. When your foot pronates too much, the muscles work harder to support your arch. If your foot remains unstable the toes bend as muscles fight to prevent the arch collapsing while you walk. Left untreated the toes will stay curled leading to corns, calluses, and pain.
Early treatment is important. At Desert Foot Surgeons we perform a detailed examination including video gait analysis to identify the reason for the unstable arch. If you do not correct the true cause of the problem it will only return. Foot orthotics are used to stabilize the arch and prevent hammertoes in the early stages. Once the toes stay bent treatment involves changing the shoes that push on the painful toe or surgically straightening the toe.
Dr. Stephen Geller, AZ Podiatrist
