What happens to the foot
The position of the toe is held by the flexor and extensor tendons and small muscles of the foot. When this balance is disturbed, the extensor pulls the main phalanx upward, and the flexor bends the middle one - the finger takes on the shape of a hammer. Hammertoe, claw and hammertoe deformities are distinguished by which joints are bent. At an early stage, the deformity is flexible: the finger straightens when pressed. Over time, the joint capsule and ligaments shorten and the deformity becomes fixed.
- Flexible stage - the finger is straightened by the hand
- Semi-rigid - partially straightens, with pain
- Fixed - the joint is motionless
- Often combined with transverse flatfoot and hallux valgus
Causes and risk factors
The most common cause is shoes with narrow toes and high heels: the toes are in a bent position for months, and the load is transferred to the forefoot. The second most important reason is transverse flatfoot, in which the arch drops and the heads of the metatarsal bones press on the sole. Deflection of the first finger outward pushes the second finger upward. A separate group consists of patients with rheumatoid arthritis, diabetes mellitus and neurological diseases in which the function of the small muscles of the foot is impaired.
- Narrow shoes and high heels
- Transverse flatfoot
- Hallux valgus deformity of the first toe
- The second finger is longer than the first
- Rheumatoid and psoriatic arthritis
- Diabetes mellitus and polyneuropathy
- Consequences of foot injuries and fractures
Symptoms
First, the person notices that the finger has become noticeably bent and is clinging to the shoe. A callus appears at the top of the joint, and under the ball of the foot there is a callus and a burning pain when walking, which is called metatarsalgia. Shoes wear out unevenly, and familiar models become tight. The pain intensifies in the evening, in hard shoes and with long walking, subsides with rest and in soft slippers.
- Sustained finger up curl
- Callus or callus at the top of a joint
- Pain under the ball of the foot when walking
- Difficulty choosing shoes
- Redness and chafing of the skin of the finger
- Sometimes - inflammation of the joint capsule and swelling
Diagnostics
The diagnosis is made during examination: the doctor evaluates the shape of the fingers while standing and lying down, checks whether the finger straightens when pressed, examines the corns and the condition of the skin. X-ray of the foot in two projections, preferably with a load, shows the degree of deformation, the condition of the joints and accompanying changes - transverse flatfoot, hallux valgus, arthrosis. Ultrasound of soft tissues helps to see inflammation of the joint capsule or neuroma. If a systemic disease is suspected, tests for rheumatoid arthritis are prescribed, and in case of diabetes, the sensitivity and blood flow of the foot must be checked.
- Examination of the foot while standing and at rest
- Deformation Flexibility Test
- X-ray of the foot bones in two projections
- Ultrasound of soft tissues for swelling and pain
- MRI of the foot for unclear pain in the forefoot
- Assessment of sensitivity and pulse in diabetes mellitus
Treatment and prevention
At the flexible stage, the deformity can be stopped without surgery. The main thing is to change your shoes: wide toe box, stable sole, heel no higher than 3-4 centimeters. Orthopedic insoles and unloading pads relieve pressure from the heads of the metatarsal bones, silicone separators and correctors hold the toe. Daily exercises help: picking up tissue with your fingers, stretching your fingers with your hands, walking barefoot on uneven surfaces. Calluses are treated by a podiatrist; you should not cut them off yourself, especially if you have diabetes. If the finger is rigidly fixed and pain prevents walking, surgery is performed - lengthening of the tendons, resection of the joint or its fixation, often simultaneously with correction of the first finger. The method is chosen by the surgeon.
- Shoes with wide toes and low heels
- Orthotic insoles and metatarsal pads
- Silicone finger spacers and correctors
- Daily gymnastics for small muscles of the foot
- Massage of feet and legs
- Professional treatment of calluses by a podiatrist
- Surgical correction for fixed deformity