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When a Hammertoe is Not Just a Hammertoe

Surgeons advise a second look at ligament in foot as culprit.  

When people notice one of their toes has an abnormal upward bend at the joint, many times they think it is a hammertoe. But often, the self-diagnosis is inaccurate and what they are actually seeing is a serious injury to the ligament in the foot, especially if found in the second toe. For this reason, it is especially important to get an accurate diagnosis.

A renewed look at treating hammertoe in the second toe reveals it may not be caused by the same factors that cause hammertoe in other toes, such as the pinky toe. It may be the result of an acute injury to the hammock-like scaffolding beneath the second toe (plantar plate ligament) that spreads out the tension put on the foot.

Hammertoes may start off as mild deformities but get progressively worse over time if left untreated. "Patients suffering from hammertoe often have pain or irritation on the affected toe when they wear shoes and can have corns or calluses (a buildup of skin) on or between the toes from the friction of the shoe," says Michael H. Theodoulou, DPM, FACFAS, a foot and ankle surgeon from Massachusetts and Fellow member of the American College of Foot and Ankle Surgeons. "But, when a patient suffers a plantar plate ligament tear, the sensation is often described as intense pain in the ball of the foot or 'walking on the bones' of your foot. The second toe tends to appear bent upward like a hammertoe and may even be red and swollen," he adds.

If a patient is experiencing foot pain or a toe deformity, it's best to have it examined right away by a foot and ankle surgeon. "Foot ligament injuries, when identified timely, can be treated through both non-surgical and surgical means. Nonsurgical interventions include resting the foot and anti-inflammatory drugs, to name a few," says Dr. Theodoulou.

But when it comes to plantar plate injuries affecting the second toe, surgery is often the most successful long-term option. "During surgery, we can actually restore the balance to the 'broken scaffolding' of the foot," adds Dr. Theodoulou. "When we do this, we generally see the second toe become once again aligned with the rest of the toes. This minor surgery can correct a big problem and help reduce the moderate to severe pain caused by the tear."

According to Dr. Theodoulou, patients who undergo surgery for a plantar plate ligament repair usually do very well following the procedure. "Although some patients require physical therapy, most patients have a six-week immediate healing process and seldom use crutches," he adds.