Surgical Options for Painful Hammer Toe by Gary W. Chessman DPM, FACFAS

Gary W. Chessman DPM, FACFAS, Podiatric Surgeon at PodiatryOrlando.com discusses surgical options for the treatment of painful hammer toe.

Often patients will present with a painful toe or painful lesion under the toe. A hammer toe procedure is usually performed on one the lesser digits. Conservative care options include wearing non-constrictive footwear, using appropriate footwear with orthotics or orthopedic inserts and on occasion, appropriate padding may be rendered. Should you, the patient, become frustrated with these conservative efforts, surgical intervention may be contemplated. If surgery is indicated, a simple procedure often will provide lasting relief. During your preoperative visit, there is a discussion of risks and benefits including relief of pain. The risks are soft tissue or bone infection, recurrence of this problem, as well as painful scars or perhaps permanent numbness. The risks and benefits will be reviewed and all questions are encouraged and should be answered prior to an operative procedure. Specific preoperative instructions are provided to the patient. Preoperative instructions such as having nothing to eat or drink after midnight on the day of the procedure. As well as directives for keeping the area clean and dry and appropriate use of post-operative medications are covered.

As you arrive in the Operative Suite, the patient is usually moved from a gurney to an operative table. Once appropriate anesthesia or sedation is provided, the involved digit is cleansed with alcohol or Betadine or appropriate antiseptic. Local anesthetic is infiltrated around the base of the toe and perhaps even into the metatarsal area as needed. The foot is appropriately prepped and draped. After the surgeon has scrubbed his hands, the surgeon is then gowned and gloved. A tourniquet may, or may not be used, at the level of the ankle, calf or thigh or a digital tourniquet may be utilized. If the apex of the deformity is over the proximal interphalangeal joint of the digit, a two centimeter dorsal linear incision is performed over the proximal interphalangeal joint. The incision is deepened through the epidermal layers of the skin. Blunt and sharp dissection is carried through the fine layers down to the level of the proximal interphalangeal joint and the lower level of the long extensor tendon which extends over the proximal interphalangeal joint. The area is irrigated, electro-cautery is utilized as necessary. The long extensor tendon is released at the level of the proximal interphalangeal joint. A sterile staple is again used to release all soft tissue structures around the head of the proximal phalanx. A small saw using either a saggital or oscillating blade is utilized to dissect the head of the proximal phalanx. Again, the area is irrigated and any sharpened edges are smoothed with a rongeur or hand or power instrumentation. The long extensor tendon is re-approximated with 3-0 Vicryl and 4-0 Prolene is used to re-approximate the skin edge. A sterile non-stick dressing is applied over the surgical incision site. A Betadine soaked 2X2 is wrapped around the digit. A supportive dressing is provided to the foot. An Ace bandage wrap may also be applied to the foot, ankle and lower leg as needed.

After the appropriate post-anesthestia period has passed, the patient is discharged to home with specific directives for appropriate use of post-operative pain medication. The need for elevation of the foot and keeping the dressing clean and dry, the patient is also advised to follow-up as directed. The patient is also advised to call if there should be any questions or problems that many arise at any time. More often than not, an uneventful post-operative course involves dressing changes through the first week to ten days as well as suture removal at one to two weeks at he discretion of the surgeon. It is important to have close follow up with your surgeon as complications may occur. Should a complication of a postoperative infection or other problems occur these are issues that can be brought to the attention of the surgeon during the post operative course following your surgical procedure. It is important for you to contact your surgeon should you have any questions or problems at anytime following your procedure.

Gary W. Chessman DPM, FACFAS - Podiatric Surgeon

Podiatry Orlando - Chessman, Gary W., DPM, FACFAS - Podiatric Surgeon
7560 Red Bug Lake Rd Suite 2024 #2024, Oviedo, FL 32765-6591
(407) 679-7444 ‎
podiatryorlando.com

Must-Know Diabetes Foot Care Tips

Diabetic Foot Care Overview

Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels.

Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious.


With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop.

Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening.

People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications.


People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems.

They should also learn what is reasonable to manage routine at home foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment.

Diabetic patients have specialized foot health needs.

Conditions such as peripheral neuropathy and poor circulation may lead to non-healing wounds which can be serious and even life threatening. Gary W. Chessman DPM, FACFAS is trained to recognize and manage these health concerns.

Gary W. Chessman DPM, FACFAS utilizes the most advanced techniques in limb preservation and out-patient wound treatment. With more than 10,000 annual wound care visits, Dr. Chessman's Foot and Ankle Clinic is one of the best wound care medical practices in Florida.

Diabetes-Related Foot Problems Diabetes can affect the feet in many ways. It can damage the nerves to the feet, making it difficult for people to detect minor injuries.

Diabetes also can reduce blood circulation, which helps such injuries heal in addition to delivering antibiotics to the sites of infection and keeping skin healthy. The disease can have an impact on how effectively the immune system fights infection. All of these factors add up to patients with diabetes having an increased chance of a foot infection as well as more serious complications that may lead to hospitalization and amputation.

Foot problems that develop in people who have diabetes (e.g., ingrown toenails, calluses, corns) should be treated promptly by a podiatrist. In some diabetes cases, the body does not produce substances that are necessary to promote the healing process. Becaplermin (Regranex®) is a medication that may be applied to sores to stimulate the growth of tissue and skin.

Podiatrists help people with diabetes prevent such serious situations through education, inspection, foot care, shoe and insole recommendations, wound care and even limb salvage surgery.

First, Most diabetic complications are preventable.

Second, People with diabetes can minimize their chances of developing complications by controlling blood glucose levels, inspecting their feet every day, not walking barefoot and alerting their diabetes doctor or podiatrist as soon as a problem arises.

Third, treatment for foot sores or ulcers that do not heal properly due to poor circulation may involve a vessel bypass. Blocked blood vessels (i.e., atherosclerosis) can be bypassed with a blood vessel graft. Improved circulation promotes healing.


diabetic foot wound

In some cases, a skin graft may be performed.

In this procedure, a piece of skin is surgically removed from a healthy part of the body and used to cover the wound. However, skin grafts on the soles of the feet can be problematic because if the cause of the wound is not corrected, the wound can recur. For example, if the wound is caused by a bony prominence in the foot, padding the area is necessary to prevent the wound from recurring.

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Phone:	407.679.7444 ‎
Location:	Serving Central Florida & all of Metro Orlando Dr. Chessman's Foot and Ankle Clinic 7560 Red Bug Lake Rd. Suite 2024 Oviedo, FL 32765 Publish Post
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Please phone the office at 407.679.7444 to set up an appointment or to learn more about our practice. Our business hours are as follows:

Monday through Thursday 9:00 AM to 5:00 PM:
Friday 9:00 AM to 12:00 PM

Many people underestimate the importance of keeping their toes physically fit. Toes take a lot of abuse from the hours we spend on our feet each day. The American Orthopaedic Foot and Ankle Society recommends doing the following simple exercises to strengthen your toes and prevent foot discomfort.

•  Toe raise, toe point, toe curl: Hold each position for five seconds and repeat 10 times. This especially recommended for people with hammertoes or toe cramps.
•  Toe squeeze: Place a small, cylindrical object, such as a wine cork, between your toes and hold a squeeze for five seconds. Do this 10 times. Recommended for people with hammertoes and toe cramps.
•  Big toe pulls: Place a thick rubber band around the big toes and pull them away from each other and toward the small toes. Hold for five seconds and repeat 10 times. Recommended for people with bunions or toe cramps.