What Is Hammertoe?
What Is an Ingrown Toenail?
When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
Causes:
Causes of ingrown toenails include:
- Heredity.
In many people, the tendency for ingrown toenails is inherited. - Trauma.
Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running. - Improper trimming.
The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail. - Improperly sized footwear.
Ingrown toenails can result from wearing socks and shoes that are tight or short. - Nail Conditions.
Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.
Treatment
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.
Home care:
If you don’t have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom’s salt may be recommended by your doctor), and gently massage the side of the nail fold to help reduce the inflammation.
Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it’s time to see a foot and ankle surgeon.
Physician care:
After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.
Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.
Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.
Preventing Ingrown Toenails
Many cases of ingrown toenails may be prevented by:
- Proper trimming.
Cut toenails in a fairly straight line, and don’t cut them too short. You should be able to get your fingernail under the sides and end of the nail. - Well-fitted shoes and socks.
Don’t wear shoes that are short or tight in the toe area. Avoid shoes that are loose, because they too cause pressure on the toes, especially when running or walking briskly.
A full list of conditions treated at Markham Podiatry can be found below:
http://www.foothealthfacts.org/Content.aspx?id=1571
*(please note that due to license and law restrictions in Ontario, not all conditions listed at this link may be treated by the clinicians at Markham Podiatry. A recommendation or a referral to an orthopaedic surgeon or another specialist may be required in some cases).
Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
Causes
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.
Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn.
Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
Symptoms
Common symptoms of hammertoes include:
- Pain or irritation of the affected toe when wearing shoes.
- Corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe.
- They may be soft or hard, depending upon their location.
- Inflammation, redness, or a burning sensation
- Contracture of the toe
- In more severe cases of hammertoe, open sores may form.
Diagnosis
Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.
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
There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
- Padding corns and calluses.
Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option. - Changes in shoewear.
Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels – conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches. - Orthotic devices.
A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. - Injection therapy.
Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe. - Medications.
Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.
When Is Surgery Needed?
In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed.
Often patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
A full list of conditions treated at Markham Podiatry can be found below:
http://www.foothealthfacts.org/Content.aspx?id=1571
*(please note that due to license and law restrictions in Ontario, not all conditions listed at this link may be treated by the clinicians at Markham Podiatry. A recommendation or a referral to an orthopaedic surgeon or another specialist may be required in some cases).