A Brief Introduction to Dr. Marshal Gwynn!

Hi, my name is Marshal Gwynn and I am brand new at blogging!  I just recently moved from Binghamton, NY to just south of Salem to work at Shenandoah Podiatry.  I was born in Portland, OR and grew up in Wenatchee, WA.  I did my undergraduate schooling at Brigham Young University in Provo, UT.  I kept moving east when I decided to attend the Ohio College of Podiatry Medicine in Cleveland, OH.  One of my fourth year rotations was done at the Salem VA Hospital.  I absolutely loved my rotation, especially when I had time to get out in the community and see some of the sites.  I still remember hiking to the Dragon's Tooth on the Appalachian Trail.  I still have pictures of the Roanoke Star when I visited.  After podiatry school I received my three years of surgical training at United Health Services Hospitals in Binghamton, NY.  I was excited when I saw an opening at Shenandoah Podiatry, because of the possibility of returning to this area. 

It was during my schooling that I met my first, and only, Virginian girl.  Long story short we got married.  I've been promising for years to bring her home to Virginia again.  As excited as I am to move to this area it doesn't hold a candle to how happy my wife is to be in the area.  It is our plan to be here for years to come.  I look forward to meeting and serving the people in this community. 


Come visit me in both offices! I am in Troutville on Mondays and Thursdays and in Blacksburg on Tuesdays, Wednesdays and Fridays.



- Dr. Marshal Gwynn

You're Active! So Keep Your Feet Fit!

Are you a daily walker, a hiker or a triathlete? Any level of intensity in your daily activities can create any of the serious and common injuries below.

Let's take care of your feet together, because healthy feet are happy feet!

Heel Pain- the most common complaint from runners caused by inflammation of the ligament which holds up the arc, known as Plantar Fasciitis

Causes:

• Plantar Fasciitis is classified as an overuse injury, the same as tendonitis. Sudden increase of activities such as going on vacation, starting a new exercise routine or changing jobs can contribute.
• Wearing non-supportive footwear on hard surfaces puts abnorman strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one's job requires long hours on the feet.
• During the summer months, we see an increased number of patients in our offices with plantar fasciitis due to walking barefoot or wearing flip flops. Obesity may also contribute to plantar fasciitis.

Neuromas- A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the 3rd & 4th toes.

The thickening, or enlargement, of the nerve that defines a neuroma is the results of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

Tendonitis- The Achilles tendon is the largest tendon in the human body and is very strong, but is also the tendon we rupture most often. Everyone who is active can suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Treatment depends on the degree of injury to the tendon, but normally includes rest, which may mean a total withdrawal from running or exercise for a week, or simply switching to another exercise, such as swimming, that does not stress the Achilles tendon.

Stress Fractures:

A stress fracture usually occurs in the feet and legs. They are more common in sports like running or jumping, because this type of activity forces 2-3 times the person’s body weight onto the lower limbs. The biggest symptom with a stress fracture is pain with tenderness and swelling that worsens with weight-bearing exercise.

Make sure to see a podiatrist so we can keep you active into your late, late years!

Salem Sprint Triathlon

Who's attending the Salem Sprint Triathlon?!

Make sure to stop by our booth and get any last minute questions answered from your friends at Shenandoah Podiatry!!

For more information about the triathlon, visit ymcaroanoke.org

Fleet Feet Foot Clinic

We hope everyone learned a lot at our most recent foot clinic at Fleet Feet in Roanoke!Dr. Kate received a TON of questions, which is what we were hoping for!!
Here are a few of the questions asked at the clinic, make sure to keep up with our events, so you can have the opportunity to learn more about your feet and ankles!!

Participant: How do you prevent plantar fasciitis?
Dr. Kate: Stretching, orthotics, night splints or Strausburg socks, Ice.

Strasburg Sock, purchase in our office today!

Participant: How long does a custom orthotic last?
Dr. Kate:  5-7 years or longer if you're finished growing.

Participant: Why do corns keep coming back?
Dr. Kate: There are pressure points, or cushion (fat in your feet) is gone or you're genetically inclined to get them more often.

Participant: How do I know when to see a Podiatrist vs a Physical Therapist?
Dr. Kate: Start with your podiatrist. If your podiatrist feels the need for physical therapy, he or she will refer you

What is Neuropathy?

Dr. Jennifer Feeny, of Shenandoah Podiatry, discusses the reason you have pain in your foot, even though it is numb. Dr. Feeny also discusses the possible causes of neuropathy and treatment options.

Your legs are different lengths? No way!

You are at the tailor having your pants altered when the tailor informs you of the discrepancy in your leg length or, if you go to a bad tailor, they may measure one leg only and you notice the difference when you wear your pants for the first time. What is going on? Did the tailor make a mistake or are your legs really two different lengths?

One of the myths that seem to have become fact is that everyone has different length legs. Yes, it may not be exact to the faction of inch (or millimeter), but from a “macro” perspective your legs should be fairly equal. Most people do not ever realize that there is a discrepancy. If the length difference is causing problems, our podiatrists can help.

At Shenandoah Valley Podiatry we can measure the limbs in two different ways. We will take a measurement with our patient lying down; this measures the actual lengths of the bones, without any soft tissue involvement or input from issues such as scoliosis. It is known as the structural limb length. We will also find the functional limb length by taking a measurement while the patient is standing and with input from all structures.

Limb length difference can cause pain and injury in various ways. Most commonly, however, the pain is limited to one side. The pain can be experienced in the feet and ankles, knees, hips, or lower back. Symptoms can be felt in the upper back and neck because the difference in limb length affects the shoulders as well. Regardless of the location of pain, it is caused by the overuse of muscles and soft tissues that are forced to work harder than usual. When there is a difference in limb length, the long limb will try and shorten itself by the foot pronating, while the short limb will try to make itself functionally longer by supinating. This causes an imbalance which leads to the injury.

How can we treat your limb length discrepancy? Sometimes it is as simple as placing a lift under the short limb. Other times, physical therapy is needed to rehabilitate the soft tissue. You have tried both of those? Sometimes you need a custom molded orthotic to best control the abnormal motions. Unlike many other podiatry offices, Dr. Feeny has a personal guarantee that if you are not satisfied with the results you see within 90 days, return your orthotics and we will refund you 100% of the money you paid.

Our patients are often surprised at how quickly we can heal their lower extremity pain with these options. Schedule your appointment today with Dr. Feeny or Dr. Kate. Remember, we are here to keep you going!

Shoes that are creating their own path in our world: Part 1

Tom’s

Tom’s are extremely colorful with many different patterns, but this is just a bonus. The best thing about these shoes is that you get two for the price of one! Deals are great aren’t they!! What is even better about this deal is that one pair of shoes goes to you and one pair of shoes goes to a child who doesn’t have any shoes to call their own. Tom’s was started in 2006 by Blake Mycoskie. His inspiration came from seeing children without shoes on his visit to Argentina. A little known fact is that many diseases can be picked up from the ground by being absorbed through the skin on the feet. Another concern is puncture wounds especially when medical treatment is not readily available. These things are not acceptable when there is something we can do about them. So, when Blake came back to the states he got very busy. During his first year in business he gave 10,000 shoes to children all around the world. Tom’s have become increasingly popular over the years. Their expansion has been exciting and inspiring. As of April 2010, Tom’s have given approximately 600,000 shoes to children all over the world! To check out Tom’s shoes online please visit www.toms.com.

                                                             Learn more at http://www.shenandoahpodiatry.com/

Morton's Neuroma

Is a painful benign fibrotic enlargement of one of there common digital nerves. It is caused by a shearing force of the adjacent metatarsal bone. It most commonly affects the third common digital nerve. Morton's Neuroma is found to be more common in females. This may be related to the type of shoe gear often worn by females. It is most common in the 4th - 6th decade.


History

Obtaining an accurate history is important to making the diagnosis of Morton's neuroma.

Common Findings

• Pain in the forefoot and corresponding toes adjacent to the neuroma
• Pain is usually described as sharp and burning
• Pain may radiate proximal
• Numbness and tingling often is observed in the toes adjacent to the neuroma
• Intermittent pain
• Massage of the affected area may give some relief
• Narrow tight high-heeled shoes aggravate the symptoms
• Patients may feel as though they are walking on a wrinkle in there sock

Exam

• Firm squeezing of the metatarsal heads with one hand while applying direct pressure to the dorsal and plantar interspace with the other hand may elicit radiating pain.
• Mulder Sign - A silent palpable click produced by the lateral squeeze test. The neuroma moves between the metatarsals.
• Passive and active bending of the toe in an upward direction may aggravate symptoms.
• Sullivan's Sign - Toes adjacent to the affected interspace splay apart on weight bearing.

Imaging

• Ultrasonography
• MRI

Differential Diagnosis

• Stress fracture of the metatarsal
• Rheumatoid arthritis
• Hammertoe
• Metatarsalgia- plantar tenderness over the metatarsal head
• Neoplasms
• Metatarsal head osteonecrosis
• Freiburg osteochondrosis- characterized by interruption of the blood supply of a bone followed by localized bony necrosis.
• Ganglion cysts
• Intermetatarsal bursal fluid collections

Treatment

Treatment strategies for Morton's neuroma range from conservative to surgical management.


Conservative

Bio mechanical

• Orthotics

Medications

• Injections- Corticosteroid- Anti inflammatory agent
• Alcohol sclerosing- Causes a chemical neurolysis of the nerve and used as an alternative to surgery for Morton's neuroma
• NSAID's- Non Steroidal Anti Inflammatory such as Ibuprofen or Naprosyn
• Tricyclic Antidepressants- Amitriptyline(Elavil)
• Anticonvulsants- Neurontin (Gabapentin)
• Pregabalin (Lyrica)
• Duloxetine (Cymbalta)

Rehabilitation Program
Physical Therapy

• Cryotherapy-Cold Therapy- Cold may be applied using an ice bag or a cold pack
• Ultrasonography- Sound waves that are transferred to a specific body area via a round-headed probe. The sound waves travel deep into tissue, creating gentle heat. The heat helps relieve pain and inflammation
• Deep tissue massage
• Stretching exercises
• Phonophoresis- Has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound

Surgical Intervention

• Neurectomy- When conservative measures for Morton's neuroma are unsuccessful surgical excision may be beneficial

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes.
Neuropathies are characterized by a progressive loss of nerve fibers

Noninvasive Testing

• Nerve conduction studies and Electromyography- A test commonly used to evaluate the function and the ability of electrical conduction of the motor and sensory nerves.
• Quantitative sensory testing
• Autonomic Function Tests
• Monofilament testing - If the patient does not feel the wire at 4 or more at 10 testing sites- the test is positive for neuropathy

Pathophysiology of Diabetic Peripheral Neuropathy

Result from vascular disease:

• Endothelial dysfunction
• Deficiency of myoinositol-altering myelin synthesis
• Chronic hyperosmolarity-causing edema of nerve trunks
• Increased sorbitol and fructose

Diabetic Neuropathy can contribute to Structural foot deformities

Hammertoes

Bunions

Metatarsal deformities

Charcot foot

Eventual tissue breakdown

The symptoms of peripheral neuropathy include the following

• Hyperesthesia-Is a condition that involves an abnormal increase in sensitivity to stimuli of the senses.
• Paresthesia- Is a sensation of tingling, pricking, or numbness of a person's skin. It is more generally known as the feeling of "pins and needles".
• Dysesthesia-It is defined as an unpleasant, abnormal sense of touch, and it may or may not be, considered as a kind of pain.
• Radicular pain-Is pain "radiated" along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation
• Anhydrosis-Means lack of sweating.

Peripheral Neuropathy Signs

• Loss of sensation in the foot- Results in repetitive stress
• Injuries and fractures
• Loss of vibratory and position sense
• Loss of deep tendon reflexes
• Trophic ulceration
• Foot drop

Treatment


Diet

• Patients with diabetic neuropathy should develop a realistic diet for lowering blood glucose. This should be guided by a nutritionist or doctor

Medicines widely used to help with painful symptoms

• Selective serotonin and norepinephrine reuptake inhibitors- example:Duloxetine (Cymbalta)
• Tricyclic antidepressants- example: Amitriptyline (Elavil)
• Anticonvulsants- example:Gabapentin (Neurontin)
• Pregabalin (Lyrica)- FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia.
• Capsaicin cream (Capsacin)- A natural chemical derived from plants of Solanaceae. This is a topical medicine and is the active component of chili peppers.
• Neuremedy (Benfotiamine)- For the nutritional management of peripheral neuropathy.

5 warning signs of foot problems in children

Foot pain in children is not something to be taken lightly or ignore. Sometimes it is hard for children to tell their parents when they are having foot troubles. Perhaps the child was born with a foot abnormality so their gait, though abnormal, seems normal to them. Or, a child may feel embarrassed about how their feet appear so they don’t want to bring it up. So, it is very important for parents to keep an eye on children's feet to keep them just as healthy as the rest of their body. Remember these feet have lots of miles ahead of them!!

Here are five things to look out for that might indicate your child is having foot pain or problems.

1. If your child is having trouble keeping up with other children~ If your child frequently lags behind other children in sports or other physical activities this could be due to flat feet causing the leg muscles to tire more easily. The muscles and feet become tired easier because the feet are not functioning as efficiently as they could be.

2. If your child suddenly stops wanting to participate in activities they enjoy~ If your child is suddenly not participating in their favorite activities this could be due to heel pain that is common in children ages 8-14. Heel pain can be caused by repetitive stress that occurs while playing sports. Too much strain can lead to pain and inflammation in the growth plate at the back of your child’s heel.

3. If your child is reluctant to show you their feet~ If a child notices a change in their feet they might be embarrassed or nervous that the change could lead to a trip to the doctors office. Start making it a habit early to check your children's feet for discoloration of the skin or nails, growths, calluses, redness, swelling or ingrown nails. Seek podiatric help for any of these signs of a problem.

4. If your child trips or falls often~ Although children are often clumsy while they are getting used to their body, repeated clumsiness can be a sign of in-toeing, balance problems or neuromuscular conditions.

5. If your child tells you they have foot pain~ Sometimes we get lucky and our children will tell us that their feet hurt. If this happens be thankful and take them to see a podiatrist right away. It is never normal for children to have foot pain and since they are growing all the time foot pain should not go overlooked. If injuries cause pain or swelling for more than a few days see a podiatrist asap.

Even if no symptoms are present and your children don’t complain of foot pain it is a good idea to get a yearly check up to make sure that the feet are growing properly.

Nail Disorders & Nail Surgery

Nails are excellent indicators of disease and provide diagnostic information.

Patients should look for some of the following nail presentations:

• Discoloration
• Brittleness
• Uplifting nail
• Pitting nail
• Splitting
• Striations
• Nail thinning
• Ridging
• Change in nail consistency
• Change in nail configuration
• Nail clubbing

Common Nail Problems:


Ingrown nails- Result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp edges of the lateral nail margin become driven into the skin of the nail groove. The nail essentially becomes a foreign body. An inflammatory response occurs in the involved nail groove. This can lead to redness, swelling, drainage, and development of granulation tissue.



Onychomycosis- Fungal infections are common, usually caused by dermatophytes.
Common causes: T. rubrum, T. mentogrophytes, and E. Floccosum.
Onychomycosis can be diagnosed by a fungal culture

Anonychia- Is the complete absence of the nail. This condition is a rare congenital anomaly.

Paronychia- Is an infection usually accompanying ingrown nails.

Beau's Lines- Transverse ridges in the nail plate.

Clubbed Digits- marked convexity of nails, with the nail becoming hard, and thick.

Eczematous Conditions- Many types of eczematous dermatitis such as atopic and contact dermatitis can affect the nail folds.

Glomus Tumor- A purplish tumor that causes pain. The nail bed will appear as a blue-red distortion.

Green Nails- Usually caused by a local Pseudomonas infection

Koilonychia- This describes a spoon shaped nail and describes a characteristic deformity in the form of a concave shape.

Onychauxis- This is the thickened, elongated, raised irregular nail.
Can be caused by trauma, fungal infection, and nutritional disturbances

Onychogryphosis- Is an exaggeration of onychauctic condition.

Onychomalacia- Refers to softness of the nails.

Onycholysis- Detachment of the nail bed from the overlying plate creates a space between nail plate and nail bed.

Splinter Hemorrhages- These are caused by capillary fragility in the longitudinal vessels of the nail bed.

Nail Anatomy


The matrix- is a stratified epithelium that produces hard keratin. The proximal matrix forms the superior nail and the distal matrix forms the lower nail.

Hyponychium- is an epithelial layer of the nail bed

Nail plate- can be separated into zones with predominantly different beginnings. The uppermost layer is generated by the proximal nail fold, the plate by the matrix, and the deepest section of the nail plate is contributed to by the nail folds and bed.

Lunula- is a white semi-lunar area corresponding to the anterior matrix.

Nail bed -consists of the hyponychium and corium over the matrix.

Surgical Nail Procedures:


Nail problems that dictate surgical intervention can include:
Abscess/ Paranychia

Persistent pain

Persistent ingrown nails

Some cases of fungal nails



Procedures:

Phenol and Alcohol Chemical Matrixectomy:

After the toe has been anesthetized, a portion or the whole nail is removed after a sterile preparation of the toe. Next 3 applications of phenol are used at the level of the matrix. The phenol is used to destroy the tissues of the matrix which will prevent further growth of the nail. The area is then flushed with alcohol and a dressing with antibiotic ointment is applied. The patient is given post operative soaking and dressing instructions.

Sodium Hydroxide Matrixectomy

Is a process similar to the phenol and alcohol chemical matrixectomy but uses sodium hydroxide and acetic acid to neutralize. The same criteria apply as for Phenol-Alcohol procedure.

                                                     Learn more at http://www.shenandoahpodiatry.com/

Plantar Fasciitis

Plantar fasciitis is one of the most common problems treated in a foot and ankle practice.

Approximately 10% of the United States population experiences bouts of heel pain.

The plantar fascia acts like a windlass mechanism.

The plantar fascia is made up of 3 distinct parts: medial, central, and lateral bands.

It extends from the heel bone to the metatarsal heads.

The plantar fascia is a thick band of tissue in the arch of the foot.

Etiology

Biomechanical dysfunction of the foot is the most common origin of plantar fasciitis.

The pathology is believed to be secondary to the development of microtears in the fascia

There is an inflammation at the fascia at its origin due to repetitive strain of the arch with weight bearing.

Symptoms
Most common complaint is pain in the bottom of the heel. Patients will typically present with post–static dyskinesia. Pain with the first steps out of bed or periods of rest so it is usually worst in the morning and may improve throughout the day or with more activity.

By the end of the day the pain may be replaced by a dull aching that improves with rest.
Most people complain of increased heel pain after walking for long periods of time.
Generally the most common pain is that elicited upon palpation of the plantar-medial calcaneus

This is at the site of plantar fascial insertion to the heel bone. Pain can occur also at the central and sometimes at the lateral insertion as well.

A tight Achilles tendon can be an adjunctive finding and can contribute to the heel pain. This is known as an Equinus.

Diagnosis
Generally the diagnosis can be made with a good history.

X rays , MRI, and ultrasonography are important modalities to the diagnosis of plantar fasciitis.

X rays may reveal a plantar heel spur, which show the presence of abnormal stresses across the plantar fascia

A heel spur forms in a manner consistent with Wolff’s law. It should be noted that the heel spur is not the cause of the symptoms and therefore does not need specific treatment or removal.

MRI and ultrasonography shows the thickness of the fascia and helps rule out other problems that are not visible with x rays .

Treatment

Nonsurgical treatment include/ Conservative:

• Rest
• Icing
• Stretching
• Nonsteroidal anti-inflammatory medication such as Ibuprofen
• Taping/Strapping
• Orthoses (pre molded or custom-made)

• Physical Therapy
• Weight Loss
• Corticosteroid Injections
• Night Splints
  

These treatments should be used in combination.

Walking, running, and jumping sports are associated with plantar fasciitis; restriction of these activities may be necessary.

Surgical:

Severe cases may require surgical intervention if conservative therapy does not improve symptoms.

Extracorporeal shockwave therapy (ESWT) is an alternative treatment for chronic heel pain using acoustic-energy shockwaves

Plantar fascia release—performed by transecting part of the fascia - This is performed through an open incision or performed endoscopically

Another relatively new percutaneous technique is Topaz bipolar radiofrequency microdebridement, which applies a bipolar radiofrequency pulse to the plantar fascia.

Interview with Dr. Feeny

As some of you know, Dr. Feeny recently took her maternity leave from our office. Since she is a Podiatrist I thought it would be valuable to ask her some questions about her feet during her pregnancy and what advice she would give other pregnant women to help take care of their feet.

Hey Dr. Feeny, Thank you so much for letting me be nosey and ask you questions about your feet. First off, did you do anything at the beginning of your pregnancy to prepare for the changes and stress that would be put on your feet in the later months of your pregnancy?

I made sure that I wore supportive shoes throughout my pregnancy. Even if I got up in the middle of the night to go to the bathroom (and believe me that was often) I wore Birkenstock sandals.

At what month of your pregnancy did you notice your feet start hurting?

My feet really did not hurt due to these preventative measures.

That is so great to hear! How did your feet handle having to be on them for a large part of the day?

Well, my feet and ankles would become swollen during the day starting at about month 6. I started wearing compression stockings/support hose which helped.

Did your pregnancy affect your shoe size or the shoes you decided to wear?

I had a hard time tying my shoes that last month so I had to wear slip on shoes. Many women think that their shoes size changes due to weight gain but it is actually due to a hormone. This hormone causes the ligaments to stretch to aid in the childbirth. The ligaments in the feet also stretch which is why it is so important to wear supportive shoes.

Wow! That’s really amazing! I never knew that. So what did you do to ease the pain and symptoms you where experiencing?

I had my hubby rub my feet!! :)

Have you noticed any changes in your feet since you’ve given birth?

The swelling is gone and I can cut my own toenails again.

What advice would you give other pregnant women about taking care of their feet?

Make sure to wear supportive shoes, do not ignore small problems, and do not try to remove any ingrown toenails by yourself.

Thanks again for taking the time to share your experience. It has been really informative!

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.