By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.
The following amusing exchange occurred between Christine, my back office assistant,
and Donna, a surgery patient, as I was tying the last suture:
Christine: Its Finito!
Donna: Funny toe?
Christine: No! Finito
Donna (quite concerned): I have a funny toe? What happened?
Christine (realizing the misunderstanding): No. Finito, like in finished! Your
toe is just fine.
Donna had a single hammertoe repaired. A hammertoe is a curled toe, similar in
appearance to your fingers if you curl them halfway into a fist. The knuckles of the toe
tend to rub on the shoes causing, at first, redness which can progress to the thickened
skin know as a corn. They can occur on just one toe, like Donna, or on all the toes
of both feet. Patients with very high arches tend to grow corns in bunches. It is not
uncommon to see such people with corns on both joints of most toes.
If you look at your finger, again, you will see that there are three bones with two
joints between them. Toes are the same. Corns can occur at either joint. Corns form when
the bone inside the hammertoe pushes the skin of the toe against the shoe. Treatment can
occur at the levels of the shoe, the skin or the bone.
Shoe therapy consists of either modifying the offending shoes by stretching, to make
more room for the toes, or wearing wider, deeper shoes. While this does not have much
appeal to women who need to wear fashionable pumps, it does work for some people.
The skin therapy consists of placing corn pads around the lesion to take the pressure
off the high point. Dr. Scholl’s makes a clear gel pad out of a material they call Cushlin.
This also has the effect of dispersing the pressure away from the corn. If the corn gets
too large, it can be trimmed. Podiatrists have been trimming corns for hundreds of years
and are still about the best there is at it.
If bigger shoes or a lifetime of corn pads are not appealing, the underlying bone can
be modified with a surgery called a digital arthroplasty. During this
procedure one side of the knuckle joint is removed and the toe straightened. The toe heals
best if it can lie undisturbed for two weeks. Wearing a stiff, flat-soled postoperative
shoe can accomplish this quite effectively. After about 10-14 days the sutures are removed
and patients can wear loose fitting shoes like tennis shoes. Soon after that dress shoes
can be worn. The main postoperative complication experienced by some patients is swelling
in the toe, which tends to diminish with time. Fortunately, Donna had no swelling after
her surgery.
For one or two corns or corns at the joint next to the nail, an arthroplasty is a
simply wonderful procedure. It can be safely performed under local anesthesia in the
office. Performed in the office we use the exact same sterile precautions as we would in
the hospital but we can save patients, like Donna, the cost of the hospital.
While most hammertoes can be fixed this way, under certain conditions the toes would
need to be fused or held straight with an implant. Digital implants are a favorite topic
of mine. I lectured on the topic at a national meeting of doctors last year) but I will
save that discussion for a later column. For now I am finito.
--------------------------------------\
ANOTHER ARTICLE ON THE TOPIC
Family
Life Magazine January 1997
Foot
Notes Column
By:
Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.
“Oh,
please do my other little toe” asked Sharian. She was referring to her right
fifth toe with a painful callus. The callus was rather tiny and nestled up
against the nail on the inside of the little toe. It was caused by the
combination of a little spur on the bone and the squeezing of her toes by her
shoes. Without the spur or without her tight shoes, she would not have the corn.
But she had a spur and she needed to wear “good shoes” at work and she had the calluses. More than anything, it
was interfering with her newest obsession: rollerblading.
She
had a corn on both little toes when she first came to see me. Another doctor had
previously diagnosed these corns as ingrown nails and treated as such.
I explained that this was an easy mistake for a non-specialist to make.
Rubbing the toe with my finger I could feel the underlying bony spur and careful
examination revealed the thickened skin of a callus. Calluses on the inside of
the little toes are quite common.
When
Sharian’s shoes squeezed her toes, the spurs on the little toes pressed
against her fourth toes. This resulted in calluses and pain. Interfering with
any part of this chain should stop the pain. Wider,
looser or no shoes at all could help her predicament. This was not an
effective solution for Sharian. Putting a pad or spacer between the toes would
also help but she was not ready to start making corn pads part of her daily
ritual. Finally I explained that I could remove this spur during an office
surgery. She chose the last method because it offered her the best chace for a
long term cure.
Sharian
had the procedure a few weeks ago. The toe was “put to sleep” using
a little local anesthesia. Through a ¼” incision I brushed away the
spur with a little rasp and closed the incision with a single stitch. I removed
the stitch three days later and allowed her
to shower and wear regular
shoes. Sharian was happy that this
office surgery was a relatively simple solution to her problem.
January
article
Page
2
By
the time you read this column I suspect that Sharian will have had the surgery
on her other toe. So if you see a
young smiling rollerblader, drive carefully. It might be Sharian.
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