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.

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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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