Lesser Toe Problems
Clawtoe and Hammertoe Deformity
Claw toes are so named because of the abnormal appearance of the affected foot. The condition involves a deformity in which the toe joint nearest to the ankle bends upward and the other toes bend downward in a fixed contracture. Claw toe can cause pain, result in the development of other disorders or be a sign of a more serious underlying condition.
A hammertoe is an abnormally crooked, contracted toe that takes the shape of an inverted “V.” This condition develops when a muscle or tendon imbalance causes the toe to buckle and eventually become stuck in a bent position. Hammertoes may occur for a number of reasons, including hereditary abnormalities, rheumatoid arthritis, traumatic injury or wearing poorly fitted shoes.
Treatment depends on the severity of the condition, but simple measures like wearing roomier shoes, custom orthotics or padded inserts to relieve pressure or taking anti-inflammatory medication to relieve pain may provide relief. Certain exercises to stretch and strengthen the feet and toes may be helpful. Toes may also be taped to correct their position and sometimes corticosteroid injections are administered to alleviate swelling and pain. Only when claw toes or hammertoes are severe is surgery recommended.
Metatarsalgia involves an inflammation of the ball of the foot. Patients typically experience a sharp pain near the toes that tends to increase in severity upon standing or walking. In some cases, patients also have a tingling sensation or numbness in the toes.
Most cases of metatarsalgia develop gradually as a result of other foot abnormalities, ill-fitting or unsupportive shoes, stress fractures or being overweight. Occasionally, however, symptoms will appear rapidly due to changes in activity level, often from an increase in exercise intensity.
Metatarsalgia is typically successfully treated with conservative measures such as resting the foot, applying ice, using pain relievers and anti-inflammatory medications, changing shoes and wearing orthotics or padding in shoes. Rarely, if these steps fail to offer relief, a surgical procedure to reposition the metatarsal bones may be recommended.
Metatarsophalangeal Joint Synovitis
Metatarsophalangeal (MTP) joint synovitis is a condition that involves an inflammation of the lining of the joint at the base of the toes. Generally caused by repetitive motion and overuse that can stress the MTP joint, this is a common problem in both men and women. Symptoms of MTP joint synovitis include pain and swelling around the forefoot that can progress to make walking and wearing shoes uncomfortable. The ligaments may develop laxity, resulting in joint instability. In some cases, the toes begin to overlap.
MTP joint synovitis can be diagnosed by taking a medical history and performing an examination of the foot. Imaging testing including X-rays or ultrasound may be conducted to confirm the diagnosis. Mild to moderate cases are typically treated by using orthotics, changing footwear, taping of the toes and cortisone injections. However, if the condition is more severe or does not respond to conservative measures, surgery may be necessary.
Morton’s neuroma is a painful condition in which excess fibrous tissue accumulates around a nerve in the ball the foot. Patients may experience pain, burning, tingling or numbness in the foot, radiating into the toes, and often report feeling as if they are walking on a pebble. The pain of Morton’s neuroma is likely to worsen over time, becoming more severe and more persistent. The condition is found more frequently in women than in men.
The condition begins when a nerve in the forefoot is compressed by the long bones called the metatarsals. This occurs when these bones move abnormally or when there is a traumatic injury to the area. Risk factors for a Morton’s neuroma include:
- Flat feet or high arches
- Bunions, hammertoes or other foot deformities
- Ill-fitting or high-heeled shoes
- Repetitive trauma caused by running or other sports
- Injury resulting from previous surgery
Treatments for Morton’s neuroma include resting the foot, applying ice packs, massaging the area, taking anti-inflammatory medications, wearing roomier shoes and using padding or tape. Medical interventions include nerve-blocking medications and corticosteroid injections. Physical therapy and orthotics can help to correct abnormal metatarsal movement.
If none of these treatments relieves symptoms, a surgical procedure may be required. One minimally invasive procedure sometimes used is cryogenic neuroablation. Exposing the nerve to freezing temperatures can disrupt the transmission of pain signals from the nerve, but it is a temporary solution. Another option is decompression surgery, in which the structure pinching the nerve, often a ligament, is removed.
Robert Spencer, DPM
Nitza Rodriguez, DPM
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