Monthly Archives: June 2015

Hammer Toe Fusion Surgery

HammertoeOverview

Uneven muscle tension results in the distortion of one or several of the small toes. (hammertoe) Pressure points develop at the raised middle joint as well as at the tip of the toe and underneath the metatarsal head. In the beginning, when the misalignment can still be corrected, it often suffices to lengthen the tendon and to cut a notch into the capsule. In a contracted misalignment, part of the middle joint is removed to form a replacement joint. Modern surgical techniques preserve the metatarsophalangeal joint (Weil or Helal osteotomies).

Causes

Footwear can contribute significantly to the development of hammertoes. Shoes that are too small force your toes into a curled position. Over time, your toe tendons adjust to this positioning, causing your toe or toes to hold a hammered shape. Athletes may be especially susceptible, because of the increased forces on the toes from shoes that are too small or tight. Heel elevation in footwear is also problematic, as it causes your toes to be pushed into the shoe?s toe box. Heel elevation additionally contributes to muscle imbalance. A common example of this is when your Achilles tendon-the tendon at the back of your leg that attaches your calf muscles to your heel bone-is too tight, causing the hammertoe tendons on the top of your foot that attach to your toes to work too hard and hold your toes in an unnatural, elevated position.

HammertoeSymptoms

People with a hammer toe will often find that a corn or callus will develop on the top of the toe, where it rubs against the top of the footwear. This can be painful when pressure is applied or when anything rubs on it. The affected joint may also be painful and appear swollen.

Diagnosis

Hammertoes are progressive, they don?t go away by themselves and usually they will get worse over time. However, not all cases are alike, some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

Non Surgical Treatment

Try to find shoes that are soft, roomy, and comfortable and avoid tight shoes or shoes with high heels. A shoe repair shop may be able to stretch a small pocket in regular shoes to make room for the hammertoe. Have a professional pedicure. Sometimes a skilled manicurist can file down a painful corn. Follow your healthcare provider’s instructions. Ask your provider what activities you should avoid and when you can return to your normal activities, how to take care of yourself at home, what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.

Surgical Treatment

Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe’s make-up. To correct a hammertoe deformity, the surgeon’s goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe’s development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.

Hammer ToePrevention

The easiest way to avoid hammertoe is to wear shoes that fit properly. Orthopaedic surgeons and podiatrists recommend shoes that have roomy toe boxes, which give the toes plenty of space to flex. Shoes that fit well should also cushion the arch in the middle of the foot. This helps to distribute the weight of the body evenly across the bones and joints of the foot. The size and shape of a foot can change with age, and many people inadvertently wear the wrong size shoe. Podiatrists recommend having your feet measured regularly to ensure that your shoes fit properly.

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Why Do I Have Bunions?

Overview
Bunions
Bunions are common but they can be misdiagnosed. We sometimes assume that any lump at the bottom of the big toe is a bunion. But as the Latin name (hallux valgus) suggests, the hallmark of a bunion is what happens to the toe itself (the hallux) rather than to the joint at its base. In bunions, the toe veers off in a valgus direction, that is, away from the midline. An outcrop of extra bone, or osteophyte, develops as the body tries to protect the exposed surface of the warped first metatarsophalangeal joint (MTP); a fluid-filled sac, or bursa, may also form, which often becomes inflamed. Foot experts are still not entirely agreed about what causes bunions. Genetics and lax ligaments are both implicated; the role of footwear is less clear. All bunion conversations seem to involve someone stating that barefoot tribes people don?t get bunions. This is not true.

Causes
The exact cause of bunions is unknown, but they tend to run in families. Wearing badly fitting shoes is thought to make bunions worse. It’s also thought that bunions are more likely to occur in people with unusually flexible joints, which is why bunions sometimes occur in children. In some cases, certain health conditions, such as rheumatoid arthritis and gout, may also be responsible.
SymptomsBunions are readily apparent, you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the Podiatrist may take x-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike, some bunions progress more rapidly than others. There is no clear-cut way to predict how fast a bunion will get worse. The severity of the bunion and the symptoms you have will help determine what treatment is recommended for you.

Diagnosis
Your doctor is very likely to be able to diagnose your bunion simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate the types of shoes you wear. You’ll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to determine the extent of your deformity.

Non Surgical Treatment
Treatment of hallux valgus nearly always starts with adapting shoe wear to fit the foot. In the early stages of hallux valgus, converting from a shoe with a pointed toe to a shoe with a wide forefoot (or toe box) may arrest the progression of the deformity. Since the pain that arises from the bunion is due to pressure from the shoe, treatment focuses on removing the pressure that the shoe exerts on the deformity. Wider shoes reduce the pressure on the bunion. Bunion pads may reduce pressure and rubbing from the shoe. There are also numerous devices, such as toe spacers, that attempt to splint the big toe and reverse the deforming forces.
Bunions Hard Skin

Surgical Treatment
There are many different procedures described to correct bunions. You should be aware that usually just shaving the bunion off, although it is attractive and minimally invasive, is usually not enough. Initially the foot will look much better but with time the bunion will recur. Arthrodesis refers to surgery performed on the great toe joint where the joint is fused. This is usually reserved for people with very severe deformities when other surgical options are impossible. Bunionectomy refers to the simple removal of the bunion itself. This is seldom used because it doesn?t correct the underlying bone problems. Osteomety is the commonest surgical procedure. The bone is cut and the bones realigned and pinned in place until they heal so that the underlying bone deformity is corrected and the bunion will not recur. The resection arstplasty refers to the removal of the toe joint and this creates a flexible scar that functions as the joint instead. In the past there has been some interest in implanting artificial joints but this has fallen out of favor due to the fact that they usually do not hold up with the normal every day stress that people put their feet through.