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Hammer Toe and Claw Toe

Hammer Toe and Claw Toe

When the large toe increasingly moves in the direction of the small toes, there is no longer sufficient space for the small toes. They must deviate upwards from the large toe. This involves an incorrect positioning of the toes with a bending in the central joint and usually with excessive stretching in the phalangeal joint. The pressure of the bones under the skin of the central joint leads to the formation of painful calluses (corns) with inflammations.

Conservative treatment
The goal of conservative treatment is initially to reduce the pressure of the toes against one another. This is successful only if sufficiently wide and soft shoes are worn. Ready made inter-toe cushions are also helpful here.
Operative techniques
The corrected positioning is maintained using a wire. This is removed after about two weeks. In passive, freely moving joints, a flexor tendon is repositioned to the extension side. Such operations can be performed under local anesthesia.

Follow-up treatment
Full weight-bearing while wearing a special shoe with a stiff sole is possible up until the time of the removal of the wire.

Morton’s neuralgia
Due to inappropriate shoes, the toe nerves may be irritated and form a local nerve swelling (neuroma), leading to pain.
If conservative measures such as shoe inserts, physical therapy, and local anesthesia with cortisone do not lead to improvement of the symptoms, the neuroma should be removed operatively.

Bone spurs
A ligament starting under the inner side of the heel bone runs forward to the toes and is the cause of the formation of a bone spur.

As the toes are increasingly extended, the tension on this ligament also increases. This leads to chronic irritation at the base of the heel bone and results in the formation of a bony extrusion, what is called a bone spur.
In acute pains, the heel should be cooled, and pills to reduce the pain and inflammation should be taken. Inserts with soft heel support also help. Extra-corporeal shock wave treatment (ESWT) has also proved successful against heel pains.

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