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Posts sent on: 2014-03-15

Mar/15/2014 




Claw Toes and Hammertoes - Patient Education - Orthogate

What can be done for the problem?

Nonsurgical Treatment
Treatment depends on how far along the process is. Early on, simplyswitching to shoes that fit properly may stop the deformity and returnthe toes to a more normal condition. If the condition is more advancedand the toes will not completely straighten out on their own, a contracture may exist. A contracture occurs when scar tissue tightens a joint and keeps it from moving through its normal range of motion.

Pressure points and calluses caused by a contracture can be treatedby switching to shoes that have more room in the toe or by placing padsover the calluses to relieve the pressure.

Surgery
If all else fails, surgery may be suggested to correct the alignmentof the toe. The main type of procedure performed for these conditionsis referred to as an arthroplasty. Arthroplasty is the reconstruction or replacement of a joint.
DIP Joint Arthroplasty
For the hammertoe deformity, an arthroplasty of the DIP jointmay be suggested. This procedure is performed through a small incisionin the top of the toe over the DIP joint. Once the joint is entered, anarthroplasty is performed by removing one side of the joint. Thisreleases the tension on the ligaments and tendons around the joint andallows the toe to be realigned in the proper position. Once the toe isin the proper position, it is held with sutures (stitches) or a metalpin while it heals.
PIP Joint Arthroplasty
One of the most common procedures to correct the claw toe deformity is an arthroplasty of the PIP joint.In this procedure an incision is made over the joint. Once the surgeoncan see the joint, the end of the proximal phalanx is removed toshorten the toe and relax the contracture around the joint. The toe isthen either held with metal pins or sutures in the straight positionuntil it heals.

As the joint heals, scar tissue forms, connecting the two bonestogether and replacing the area where the joint once was. Surgeonsrefer to this as a false joint (or pseudo joint) because thescar tissue allows a bit of motion to occur between the two bones whilekeeping them from rubbing together and causing pain.
MTP Joint Release
If clawing is a problem, then the MTP joint may also have to bereleased to relieve the contracture of this joint and allow theproximal phalanx to come into the correct position. This procedure isperformed by making an incision on the top of the toe over the MTPjoint. The surgeon then releases the tight ligaments and tendons untilthe toe easily moves back into the proper alignment. The toe may beheld in the proper alignment with a metal pin until the soft tissuesheal. The pin may remain in place for three or four weeks.



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