Hammer toe is a deformity in the digits of the foot (the toes). Toes share the same basic bone structure as fingers. This includes separate bones that have joints. In hammer toe, the joints, usually those closest to the rest of the foot, are misshapen. This gives the toes an appearance of curling or bulging over the top of the nail, when they should be flat and thin. Hammer toe usually occurs in the second, third, and fourth toe of the foot. It is not a source of pain in all cases, but many people experience chronic pain in toes that have this deformity.
Many cases of hammer toe occur in people who wear high-heeled shoes, particularly narrow ones that compress the toes together. The joints become misshapen through the abnormal stresses on them, particularly if these types of shoes are worn regularly. Pain in the deformed joints can ease over time if better-fitting shoes with adequate space for toes are worn instead. In some cases however, the pain from this condition becomes chronic. Hammer toe also occurs as a symptom of genetic diseases, such as Charcot-Marie-Tooth disease or Friedrich’s ataxia. In these conditions, there are often deformities in many aspects of foot structure, affecting both muscle and bones. This is often accompanied by chronic pain. Painful hammer toe is also seen in cases of arthritis, in which inflammation of the joints is the source of pain. It can also result from conditions such as stroke or diabetes, which is often associated with painful neuropathy (nerve damage).
Pain signals from the feet or toes are sent by major spinal nerves in the lower back to the brain. Therefore, to control chronic pain in toes that do not respond to conventional medication, these nerves can be targeted directly in the course of therapy. One of the techniques that can be used to do this is a spinal nerve block injection(more commonly known as nerve blocks). In this procedure, the area of the back to be injected is anesthetized, and the physician then locates the nerve with diagnostic equipment, including imaging techniques such as fluoroscopy. A needle is then inserted into close proximity with the nerve, and pain-blocking drugs are delivered to it to stop it from sending pain signals to the brain. These drugs are anesthetics, such as lidocaine, and steroids to treat the inflammation affecting the nerve. Nerve blocks are effective, usually giving several weeks of pain relief. There are some risks associated with the procedure, mostly adverse reactions to the drugs injected. These include numbness, discomfort, and in some cases neurological complications such as respiratory depression. These complications can also occur if the wrong area of the spine is injected, or if a blood vessel is injected by mistake. Possible side-effects of the steroids are weight gain, an increased risk of arthritis and infection, mood swings, and stomach ulcers. An alternative, or next step in pain treatment if nerve blocks prove unsuccessful, is spinal nerve block injection (RFA) of the spinal nerve in question. In this procedure, electro-thermal (or radiofrequency) impulses are applied to the nerve to destroy the parts of it that are responsible for pain signals. As with a nerve block, this is done under local anesthesia and with imaging and diagnostic equipment to accurately locate and destroy pain-delivering nervous tissue. RFA can result in several months of relief from pain, before the “pain fibers” of the nerve reassert themselves, in which case a repeat procedure can be carried out. Risks of RFA include bleeding, discomfort, and infection at the site where an RF probe was inserted. There is also a low incidence of more extensive nerve damage, which can cause motor difficulties. Spinal cord stimulator (SCS) is a newer method of pain relief. This technique involves implantation of thin, wire-like implants into the space of the spinal cord near the nerve to be treated. These implants are connected to a controlling device via leads, with which the patient can activate pain relief. This is achieved by mild electrical signals, emitted by the implants that disrupt the pain signals coming from the nerve. SCS has been shown to achieve pain relief lasting several months post-insertion, and has potential in treating foot and toe pain in Charcot-Marie-Tooth disease. The risks are similar to those of RFA.
Hammer toe is a condition in which the joints of the second, third, and/or fourth toe of the foot are deformed, giving a curled-up or bulging appearance. This can result from wearing narrow, ill-fitting high-heeled shoes or from genetic conditions such as Friedrich’s ataxia. It can also result from inflammation associated with diseases, such as arthritis or diabetes. Treatments for hammer toe, if accompanied by pain, can take the form of anesthetic injections or ablation of the spinal nerves affected. Spinal cord implants, which stimulate an interference of the pain signals coming from the nerves, are also a viable option for hammer toe pain.
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