Hammertoes

Digital contraction deformities include hammertoes, clawtoes, and mallet toes.



There are three main causes of digital contracture deformity:

Flexor Stabilization- occurs about >70%. The muscles in the back of the foot and leg fire earlier and longer to stabilize the hypermobile fore foot. This results in overpowering the little muscles in the foot causing the hammertoe. It is possible to see rotation of the 4th and 5th digits with this type of deformity.

Extensor Substitution – is associated with a high arch foot, foot drop, and a weakness of the muscles in the front of the leg.

Flexor Substitution – is the least common cause of digital contracture, and occurs due to weakness of the muscles in the back of the leg.

A mallet toe involves bending of the far toe joint downward and may be associated with a long digit.

Hammertoes involve upward bending of the the first bone in the digit and downward bending of the middle bone in the digit.

The clawtoe involves downward bending of both the middle bone and the far bone of the digit.

Symptoms associated with advanced digital contracture deformity include painful motion, painful hyperkeratotic lesion (Thickened Skin), inability to wear regular shoes, contracted painful toe which is short.

Treatment for claw toes and hammertoes depends on the severity of the deformity.

Goals are to keep the foot comfortable:

If biomechanics is the reason for the hammertoe deformity tan the patient can be fitted for custom-molded orthotics.

Changing to a wider pair of shoes, with more depth in the toe box.

Hammertoe pads or Hammertoe cushions can also be used on hammertoes.

Padding placed under the toes, with a strap that is placed over the toes which helps to straighten the toes.

Pads and cushions can help to alleviate pain and irritation of the toes, these pads however will not change the deformity.

It is possible that the soft tissue structures can begin to tighten. A rigid deformity can develop in such a case.


When conservative care fails and there is considerable pain at the hammertoes, surgery is then considered.

Hammertoe surgery involves straightening the toe through either an arthroplasty by removing a small piece of bone of the digit, or arthrodesis (fusing the joint) using a wire or implant.

Arthroplasty is a minor surgical procedure that may be used to treat hammertoes. In this procedure, the head of the first bone in the digit is removed, allowing the toe to straighten. If the affected toe does not straighten sufficiently after arthroplasty, a number of progressive stepwise soft tissue procedures can be used to attempt to straighten the toe.

In some cases an arthrodesis is necessary. Arthrodesis involves fusing two bones together, typically the first and second bones of the digit. The articular cartilage is removed from each bone. They are then held together with either a pin or an implant.

Following surgery, the patient is placed in a surgical shoe or boot and the patients has limited activity for several weeks.

Introducing Dr. Daniel Yeaman

I am pleased to announce that Daniel Yeaman, DPM has joined our team at Shenandoah Podiatry. A native Virginian, Dr. Yeaman recently completed an extensive fellowship in diabetic wounds and limb salvage following a three-year residency, specializing in reconstructive foot and ankle surgery.

His specialties are management and reconstruction of the diabetic foot and ankle. He also treats ingrown nails, skin conditions of the foot such as plantar warts, fungal nails and painful foot conditions such as heel spurs.

He has traveled to Honduras to assist in surgery for children born with foot deformities such as clubfeet and has volunteered locally throughout his education.

In his free time, Dr. Yeaman enjoys hunting, fishing and spending time with his family.

We strive to provide the best care possible for our patients and feel his addition will contribute greatly to our efforts. Please welcome Dr. Yeaman as we all work towards your good health.

Dedicated To Your Healthy Feet,

Dr. Jennifer Feeny

King Tut's Club Feet

When we think about world rulers, the ones who changed history, we usually concentrate on the changes they’ve done rather than think about the human aspects of their lives. Recent CT scans and DNA tests reveal a lot about the great Boy-King of Egypt’s very human life. They found out that he had club feet, Kohler’s disease, and a cleft lip just to name a few, yet he went on to rule the empire of Egypt for 10 years from 1333 B.C. until his death at the age of 19.

It is amazing to see that he was able to rule such a great empire with these ailments despite the physical pain that they cause and also though they caused visual changes in him as well. Club foot is a congenital deformity in which the foot turns inward and downward at birth causing that outer side of the foot to become the area that is walked on. Kohler's disease is a condition, where the navicular bone in the foot undergoes avascular necrosis. Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. Both of these ailments are very painful and make it extremely difficult to walk.

Often people have a hard time following leaders if they seem physically weak but King Tut was able to pull it off despite being in pain everyday and having to use a cane to walk. It is inspiring to know the lives that people have lead even with foot pain but makes me so thankful that we now have podiatrists and don’t have to live it foot pain!!

Fun fact: Over 130 walking sticks where found in King Tut’s tomb.

Olympic Feet

With the winter Olympics going on right now, it makes me think of all the different sports we are able to participate in. Sports that ask us to run, jump, kick, twist, turn, and glide. Sports that ask for speed and agility that, without the versatility of our feet, would not be possible or at least would look quite a bit different!

The 26 bones and 33 joints in each foot allow us to effortlessly become mobile in many different ways. When I see someone skate their heart out down the length of the ice and stop on a dime, my breath is taken away. Though it may seem like the boot is doing the work, anyone who has ice skated before and had sore feet the next day will tell you otherwise. The complexity of the foot is amazing. And even more amazing than that are the mechanics that make a human foot work properly, the podiatrist.

Though feet are not visible during the winter Olympics, they are still a very important part of the games. A ski or a skate is merely an extension of the foot. Bobsledding wouldn’t be possible without the help of our feet mustering up enough momentum to make the sled go. Even changing the balance and placement of your feet in curling can change your game.

During the 2010 winter Olympics root for team feet! And keep in mind all the amazing things your feet do for you everyday.

Though we are all about feet, we want to recognize those who haven’t given up the games they love because their mode of movement is different than the movement of the original game. We want to recognize how these sports have been modified to work for all kinds of people. For more information about wheelchair and ambulatory sports check out http://www.wsusa.org/.

American Podiatric Medical Association Podiatrists Perform Life-Saving Amputations in Haiti

Above: A team of doctors works to perform foot surgery on a victim of the January 12 earthquake in Haiti.


Bethesda, MD – When a devastating earthquake rocked a vulnerable Haiti on January 12, lives of numerous American podiatrists with ties to the country and its people were rocked, too. For years, American Podiatric Medical Association (APMA) doctors have traveled to the diabetes-plagued nation on a mission to save lower limbs from amputation as a result of the disease. In fact, nearly seven percent of the estimated nine million Haitians have diabetes, and far too many don’t even know they have it. Ironically, APMA doctors, such as Patrick DeHeer, DPM, of Carmel, IN, who set up a diabetes wound care center in Port-au-Prince with the intent of preventing people’s legs, feet, and toes from being amputated, this month found himself back in the devastated city to perform the surgery he tried so hard to avoid—amputations. He did it not because of diabetes, but in order to save lives.

"It is chaos here—terrible injuries, people crushed, compartment syndromes—many of which are ending up in amputations," reported Dr. DeHeer, who served as a wound care director for a field hospital at a United Nations (UN) compound overseen by Project Medishare in Haiti’s capital city. "I just assisted on a below-the-knee amputation with an orthopedic surgeon on a 12-year-old girl. It is overwhelming."

This type of limb removal surgery, such as the one Dr. DeHeer described, has become all too common since the disaster hit. Infections such as gangrene have made amputations imminent without enough antibiotics and proper sterilization. The Pan American Health Organization reports there will be thousands of amputations in Haiti—and nearly half of the people impacted may lose more than one limb. Haiti’s high prevalence of diabetes and lack medicine to properly regulate the disease may only compound the amputation demand, as well as the need for expert podiatric care.

“It’s a tragedy that such an already fragile nation has to deal with such devastation and loss,” said APMA President Ronald D. Jensen, DPM. “As a podiatrist, I know firsthand how tragic it can be for a patient to lose a limb. There is a tremendous amount of help and support that the patient and their family require that is a challenge to provide in the best of circumstances. The people in Haiti will need help for a very long time.”

APMA podiatrists across the country continue to deploy to the shaken country to offer medical assistance. Only time will tell what toll the surge in amputations will have on the plight of the Haitian people.

To read more about APMA podiatrists’ missions to Haiti, visit www.apma.org.

Helping Hatian Feet

It is about three weeks after the 7.0 earthquake hit Haiti. Sadly, the news of this devastating event is fading out of the spot light of our media and out of the minds of those in our country though the effects of this earthquake have hardly vanished from the eyes of the Haitians. Some of us have not forgotten, others of us just need a little reminder to bring us out of our own routine. Perhaps you have been keeping up with the news in your own way; checking blogs, talking to friends, watching videos, doing what you can to not let the Haitians vanish into the rubble that is now their country. Perhaps you have given your time, informed others, or given monetarily to show the Haitians your support. Every little bit helps and giving can be fun especially when you can find ways to give that resonate with things you are passionate about.

Since we are all about feet, we wanted to share some ways with you that will help the feet of the people in Haiti. Through these websites there are several ways that you can find to help protect the Haitians from the debris left by the earthquake.

http://www.soles4souls.org/

http://www.shoes2share.com/

Check them out today!

The Strength of Feet: A Remembrance of Martin Luther King Jr.

Today we remember a man who called on the feet of our country to bring about the changes that we needed. We remember those who marched for freedom and stood strong on their beliefs. We look back into history and take into account the miles traveled towards a more equal future for all Americans in our country.

From the beginning to the end of Martin Luther King Jr’s days as one of the most influential people in the civil rights movement, walking was an extremely important part of the campaign to bring about change. From the Montgomery Bus Boycott to the march supporting sanitary waste workers in Memphis, activists used there feet to get their voices heard and heard they were.

One momentous march, the ‘March on Washington for Jobs and Freedom’ has inspired people everywhere to get off the couch and get moving towards the things they believe in. It inspired local marches throughout cities all over the U.S. during the civil rights movements and beyond. Even today we see different groups of people taking to the streets to stand for what they are passionate about and to bring light to inequalities that unfortunately are still present in our world.

Today, take a few steps and remember those who rallied together and used their feet to peacefully make a difference in our world. Take a few steps for those in our history who have fallen fighting for the freedom we enjoy. Today, take a few steps for Martin Luther King Jr. and everything he stood for.