Hammertoe Surgery and Neuropathy

Often the hammertoes are the result of the neuropathy itself. It's hard to imagine how that nerve damage could be corrected by surgery. Are you able to extend your toes by pulling on them? If so, that would suggest the hammer toes are due to the neuropathy.

Hi Debbie @dbeshears1, I've had hammertoes pretty much most of my adult life and can't really remember when I first noticed them. My neuropathy symptoms came on gradually and 20+ plus years later in 2016 when I finally decided to see a neurologist to get a diagnosis, he actually asked me if he could take pictures of my hammertoes for his upcoming training session he was working on. He said they were typical for folks with peripheral neuropathy. Fast forward to a few months ago when I started thinking if I should check into having surgery to see if it might help with my balance issues I made an appointment with a Mayo foot specialist. After the exam he said they really don't consider doing surgery unless you have open sores or ulcers on the toes that won't heal that could lead to a bad infection and possible amputation. Since I didn't have blisters or sores on the tops of the toes he said just to keep wearing shoe with a wide toe box and softer material on top so that it doesn't rub sores or put pressure on the toes.

My wife's older sister who is an RN had a couple of hammer toes but never had neuropathy. She had the surgery which straightened them out and said she didn't really have any pain and was glad she had it. That's one of the reasons I decided to look into the surgery. The foot specialist I talked with said there can be a lot of risks associated and the surgery results might make it worse which gave me more cause for concern.

Thanks John - A big part of my dilemma is that my orthopedic doctor and my Neurologist are each focused on their own specialty, and I can't seem to get either of them to think the overall/overlapping concern of mine. I'm not doubting the benefit (for a normal person) of fixing the toes and making shoe fit, stride/gait, and hence balance better. But I'm not able to get a professional answer to 1) Will surgery be a somewhat permanent correction or is there a great chance that my PN will undo it? 2) Will surgery further numb/injure nerves, thereby having a harmful consequence to PN by straightening the toes? That's why I'm making this appeal to the best group of folks I know that can help me with this big decision. Unfortunately, I don't know what other medical professional I can ask. Thanks so much for sharing your investigations, it sounds like you had to do a lot of legwork to get to a good decision too (sure wish it could be a little more cut & dry for us!)

You can bet that the next time I take my shoes off, I'll be testing the toes! Thanks for your input & thoughts. The last thing I'd want to do is endure surgery that has only temporary results or would make my PN worse! I am already challenged with walking; I don't use a walker inside my house, but have one for longer outings or shopping, so being a bit incapacitated more for 3 weeks (one foot) while recovering would indeed be a hardship, so I want to be very careful with this decision.

I forgot to mention the biggest pain for me with the hammertoes is the toenails sometimes break off and snag my compression socks when I'm trying to put them on in the morning or my loose diabetic socks after I put moisturizing lotion on my feet and legs at bed time. It is a pain for an old man to trim the toenails. I can't straighten my toes by pulling on them and can't see the toenail to trim it. I have to put the clippers in the right spot under the toenail and and try not to cut the skin which hurts like the dickens.

John - Isn't it amazing what we endure that so many folks take for granted? I honestly do count my blessings, but I scare myself silly with a pair of toenail clippers in my neuropathy affected hands! Reaching the toenail is just the first big hurdle in the process!

John,
I too have had hammer toes and gave them to my children. Thanks to recent issues in the other foot, my hammer toe became worse. I massage it, pull it, then my foot and calf. It feels better. Also, the shock wave helped. The same foot spent six months in a walking cast for an injury that would not heal. The toe was the same.
JFN

I took my mother to a podiatrist to get her toenails trimmed. asked about just removing the nails and he advised a against it. He said the neuropathy would make healing difficult and infection that would not heal could result in loss of a foot or leg. I knew someone who had that happened be because of diabetic neuropathy. I'm so glad we just contined with the care of the podiatrist. Be careful.

@dbeshears - When I was first getting tests for PN, my doc sent me to the University of PA to see a neurologist who specialized in genetic testing. On initial visit, one of his questions was did I have anyone in my family with hammer toes. I said yes, grandmother on mom's side, she had one hammer toe on each foot. My mom also had one. I do not have hammer toes but he did blood test for CMT, came back negative. Could that be a hint for cause of PN?

I asked my prior Neurologist, actually from a recommendation you made several months ago. He basically said my EMG says Axonal Sensorimotor PN, so that tells all we need to know, that it meant no CMT, no SFN. No need for CMT testing, no need for skin biopsy to test for SFN, and no need for an MRI to see if it could possibly be anything else contributing. Basically didn’t matter. At the same time, my SC Medical University neurologist recently tried to tell me that my extreme cold & heat feelings in hands and feet that came immediately with my sudden PN was not from my PN! I had to argue that one with her. Geez, how many folks on here talk about that? I would think it’s Neuropathy 101! She also didn’t think my inability to sweat was attributed to my PN. It confused me why she wanted so much to convince me they weren’t, when I know darn well. She was rushed, and not prepared to hear my symptoms being different than her standard list; it makes me really believe that the reason was because those two symptoms aren’t as common with the Axonal definition she had vs. SFN perhaps. Her final notes did list them as I reported, but I wonder what she was thinking.