Foot and Ankle

Claw toe is similar in appearance to hammertoe, but the distal joint of the foot is also bent, giving your toes a claw-like appearance. Tight, improperly fitted shoes may be a factor of claw toe, but nerve damage, diabetes, alcoholism, and other vascular and muscle damaging conditions also can cause the muscle constriction. Failure to treat claw toe may result in permanent toe malformation that requires surgical intervention.

Symptoms

Claw toe may begin as a slight curve affecting multiple joints of the toe. It advances to the curved, claw-like appearance in which your toes bend upward from the metatarsal bones at the ball of your foot and downward from the middle joints. Unlike hammertoe, with claw toe the distal joint continues to bend and curls the distal phalange under the foot. That two-part curve is a clear sign of later stages.

Additionally, the tops of toes or ball of the foot may develop corns and calluses.

Claw toe may also indicate, or be caused by, neurological disorders that weaken foot and toe muscles, resulting in imbalance and bending. Curvature after trauma may also indicate the beginnings of claw toe.

Treatment

Like hammertoe, the joints affected are flexible at first, but can become rigid over time. Non-surgical treatments such as better-fitting shoes, therapy, splints, and orthotics can help relieve symptoms. Additional treatment is necessary for other neurological conditions that cause claw toe. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their appropriate alignment and movement.

Floating toe is a common complication of Weil osteotomies. With Floating toe, also known as flail toe and elevated toe, the toe sticks up in the air rather than in the aligned, biomechanical position of other toes. At times, the affected toe will even “cross over” an adjacent toe, causing more pain, discomfort and problems with footwear.

This complication occurs if the osteotomy of the metatarsophalangeal bones and joint surgery did not address the underlying cause of the initial problem, such as hammertoe.

Symptoms

• Toe sticks up in the air, rather than flat and aligned like other toes.
• Toe is inflamed, red, and painful.
• Joint is unstable, either too stiff or too loose.
• Floating toe may be seen with crossover toe.

Treatment

Non-surgical physical therapy of floating toe may help. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their proper alignment and functionality.

Hammertoe is a condition caused by the joints of the metatarsal and phalanges contracting and bending the toe into an arched position that resembles a hammer. A common cause of hammertoe is a tight toe box in shoes, typically found with high heels that may be too small. The size, angle, and structure of the shoes force the toes into a compromised position, causing poor circulation, restricted movement, plus aggravation to the bones and ligaments in the foot and toes. Trauma is also a cause of hammertoes, and heredity may play a factor.

Early stages of hammertoe are mild, and the compromised joints are still flexible. At this stage, non-surgical treatment and appropriate footwear can help. Without treatment, however, the condition will worsen and joints will become stiff and inflexible. At that point, surgery is the only option.

Symptoms

Earliest stages are unsightly and uncomfortable but may not yet resemble the curved appearance of later stages. The appearance of hammertoe and its distinct shape is an indicator.

Symptoms of hammertoe include:

• Wearing shoes causes pain and irritation on toes.
• Corns and calluses appear between two toes, the ball of the foot, or on an affected toe that rubs against the shoe.
• Long-term friction also can cause open sores on toes.
• Burning sensation and a red, and inflammed appearance.
• Curved appearance that progresses if left untreated.
• Stiff, inflexible joints.

Diagnosis and Treatment

Early stages of hammertoe may appear as simple foot problems, but the curved appearance indicates a condition that must be treated or it will worsen.

A foot and ankle surgeon or podiatrist will review your symptoms and thoroughly examine your toes and foot. Manipulation of foot and toes and degree of toe contraction will show whether the toe joint is flexible or rigid. X-rays may be required to diagnose how severe the toe or toes are deformed.

Early stage hammertoe may be treated non-surgically with better-fitting shoes, therapy, splint, tapes, and orthotics. If surgery is required, your surgeon may recommend one or more procedures to restore toes to their proper alignment and functionality.

Mallet toe is similar to hammertoe, except the distal joint near the end of the toe, rather than the middle joint, contracts downward. The bend of the toe can cause severe, painful corns and possibly ulcers on the tip of the toe. Because of its length, the second toe is most at risk for developing mallet toe.

Mallet toe can be caused by injury, tight shoes, muscle and bone imbalances, and arthritis.

Symptoms

In early stages of development, mallet toes still have joint flexibility. As time progresses without treatment, the joint and tendons contract and freeze, causing misalignment and creating the mallet shape and position. Symptoms include:

• Swelling, redness and irritation
• Corns, calluses, and possible ulcers in diabetic patients

Treatment

Non-surgical treatment of mallet toe includes better-fitting shoes, callus shaping and care, toe pads, low heels and therapy.

Your Metatarsophalangeal joint (MTP) connects your phalanges (bones of the toes) to the longer metatarsal bones in your foot. This joint forms the ball of the foot. Deformities of the lesser toes (all but the big toe), can cause the MTP joint to become unstable, causing the second toe to either cross over the big toe or push against the third toe in a sweeping effect. Either of these situations can result in a condition known as hammertoe, one of the most common deformities. Hammertoe causes difficulty and pain in walking and can cause the joint to stiffen if left untreated.

If your MTP joint requires surgical intervention, we offer a state-of-the art approach to treatment that may help reduce some complications common in standard toe surgery:

• Floating toes
• Loss of range of motion
• Stiffness and residual pain^1,2

The HAT-TRICK MTP Joint Repair System provides a complete repair of the lesser MTP joint that is less invasive and more anatomically correct than current surgical standard of care techniques.

Less Invasive

Traditional MTP surgery requires a metatarsal osteotomy. This means bone (“osteo”) removal (“otomy”) in order to shorten the metatarsal bone and re-align your toe. The bone removal is held in place with screws and wires that cause additional pain and discomfort during the healing process.

The Proximal Interphalangeal Joint, or PIP Joint, is the second joint of your lesser toes. Hammertoe and claw toe conditions can cause this joint to become fixed and unable to straighten. This is a gradual deformity and cannot be straightened by any means other than surgery.

The surgery required to straighten your toes typically involves removal of bone portions through an incision on top of your toe. The bone removal allows your toe to be straightened. Once straightened, a long wire known as a K-wire is pushed through the front of your toe, with a portion sticking out of the end of your toe. This wire helps keep your toe in a fixed position for four to six weeks, and is then removed.

These types of surgery have multiple issues with pain and fusion, and 10 to 46 percent of patients are dissatisfied post-surgery. ¹

The complications of a K-wire type of surgery are many and include²:

• Increased swelling and pain
• Pin-tract (site of wire insertion) infection
• Delayed or incomplete joint fusion
• Painful removal of wire

Less Invasive

The HAT-TRICK PIP Fusion system provides an alternative to wires sticking out of your toes. The HAT-TRICK PIP Fusion system consists of a device known as a PEEK (polyetheretherketone) implant, which is a technology that has been used in orthopaedic and spine procedures for many years. The PEEK implant is radiolucent, which allows your surgeon – and you – to see the fusion progress on an x-ray. By contrast, metal implants such as wires and screws appear solid on an x-ray and do not always allow a full view of your healing. The HAT-TRICK PIP Fusion system also provides your surgeon with a technology designed to achieve a better fusion and, ultimately, a less invasive healing process.

The surgery involves an incision to gain access to the joint and minimal bone removal. Your surgeon will implant the HAT-TRICK PIP device into your toe with half in the middle phalanx and half in the proximal phalanx. This unique compression technology is exclusive to the HAT-TRICK PIP Fusion System and holds your toe in place, allowing full fusion to occur.

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, redness, swelling and, sometimes, an infection.