Patients experiencing painful, bent toes may have a condition called a hammertoe. It’s a condition often caused by wearing badly-fitting shoes or shoes that don’t allow proper space for the toes. Trauma and lack of proper muscle balance can also be factors. In many cases, conservative treatments can relieve a hammertoe, but in severe cases, surgery may be needed.
Here are a few facts about hammertoes and how to treat them.
What Are Hammertoes?
A hammertoe is a foot deformity that is caused by an imbalance in the tendons, ligaments, and muscles that keep your toe straight. Tight footwear, an abnormal foot structure, foot trauma, or certain diseases can cause hammertoe.
A hammertoe is when the middle joint of the toe bends into an abnormal and painful position. It’s most common in the three middle toes. Certain factors can increase the risk of developing hammertoe, including toe length, diseases such as arthritis or diabetes, sex (it’s more common in women), and age, because the older you get, the greater the risk of developing hammertoe.
One way to prevent hammertoe is to make certain you wear comfortable footwear with plenty of room for your toes. Shoes with pointed toes tend to squeeze the foot, causing deformities. It’s the main reason why women tend to get hammertoes more than men because high-heeled shoes tend to have pointed toes.
Treatment of Hammertoe
If the toe is still flexible, it’s possible to treat hammertoe without surgery. Your doctor likely will recommend changing your shoes to more comfortable footwear and wearing orthotics or pads to reposition your toe. This should relieve pain and allow the joint to heal properly.
Your doctor may also recommend exercise to return flexibility to the toe. These exercises are meant to stretch the ligaments and tendons in the toe and strengthen the muscles, allowing the toe to return to its proper position. Exercises could include picking up objects with your toes and curling and uncurling them.
If conventional methods don’t work, surgery may be needed. The surgeon can do what’s called a tendon transfer, where he moves the tendon from the bottom to the top of the toe to allow more flexibility.
Another procedure is a joint resection. The surgeon cuts the tendon and ligament at the top of the toe to allow it to flatten out, and the end of the bone is cut off to make the toe easier to move.
The third procedure is a joint fusion. The tendon and ligament are cut to flatten the toe, and the two bones in the toe are screwed together so that they fuse into one bone, keeping the toe flat.
Hammertoe surgery is usually done on an outpatient basis, so you can go home the same day. Depending on the type of surgery and the severity of the hammertoe, recovery can take anywhere from six weeks for the transfer to three months with fusion.
Diagnosing Hammertoe
Diagnosing hammertoe will require visiting a doctor or surgeon. At Princeton Orthopaedic Associates, we have a team of experts who know how best to treat your hammertoe. If you suspect you have that issue, we may be able to help. Contact us today for more information.
Compartment syndrome refers to the swelling of muscles in groups surrounded by tissue called the fascia. These muscle groups can cause severe complications if they swell too much because the fascia doesn’t stretch, so it contains the swelling and puts pressure on the muscles, nerves, and blood vessels. There are two types of compartment syndrome: acute and chronic. One can be managed, while the other requires an immediate visit to the emergency room. The muscle groups in particular are usually in the arms or legs.
Acute Compartment Syndrome
Major trauma or other medical emergencies can result in acute compartment syndrome, during which the muscles swell rapidly in the fascia. This can happen with bone fractures or even severely bruised muscles called by impact, such as during a car accident. It can also be caused by a cast or splint put on too tight. If that’s the case, removing that cast quickly can alleviate the compartment syndrome and remove the need for surgery. But for traumatic injuries, surgeries likely will be required.
Because the muscles can only swell so much before they hit the fascia, they begin to cut off circulation and nerve usage. This can lead to parts of the muscle dying, a condition called necrosis. Once the tissue is dead, it cannot be saved and must be removed. That is why immediate surgery is required for acute compartment syndrome. The patient should visit the emergency room right away.
Symptoms of acute compartment syndrome include:
Sudden intense pain in the muscle that worses with movement
Burning in the skin
Muscle tightness
Numbness
Chronic Compartment Syndrome
Chronic compartment syndrome is often found in athletes and is an injury caused by overuse of a group of muscles. It most often affects the quads and calves in the legs. The swelling is less severe than acute compartment syndrome. Lessening the activity that causes the swelling can allow the muscles to heal and the swelling to subside. If it doesn’t work, however, the patient may need surgery to recover.
Symptoms of chronic compartment syndrome include:
Numbness
Swelling of the muscle that doesn’t go away
Limited range of motion in the leg or foot
Treatment and Recovery
The surgery is called a fasciotomy. The surgeon will make an incision and cut open the fascia, which will allow the muscle to swell without causing additional damage. The muscle will then be given time to heal and return to normal. The wound is closed slowly as the swelling goes down.
Recovering time can vary, depending on the size of the wound and the length of time it takes for the swelling to go down. The patient likely will be in a splint or on crutches for 9-12 weeks. Full recovery can take an average of 3-4 months. Physical therapy may be needed to return range of motion and to learn how to exercise properly without allowing the swelling to return.
If you suspect compartment syndrome, contact Princeton Orthopaedic Associates as soon as possible.
Carpal tunnel syndrome is a common ailment caused by pressure on the medial nerve that runs down the arm, through the wrist, and into the hand. The syndrome is named for the medial nerve’s passageway through the wrist. Carpal tunnel syndrome is often caused by repetitive motions done while the wrist is bent, such as when using a mouse or keyboard.
Symptoms and Diagnosis of Carpal Tunnel Syndrome
Most patients experience numbness or tingling in the thumb, index, and middle fingers. Sometimes, the numbness spreads to the ring finger and the medial nerve in the wrist and forearm. Patients can also experience pain in these areas.
Doctors at Princeton Orthopaedic Associates will diagnose carpal tunnel syndrome through a full patient workup. We will check for recent injuries, perform a physical exam of the hand, wrist, and forearm and obtain imaging of the wrist through either an x-ray or an MRI.
Treatment and Prevention of Carpal Tunnel Syndrome
Carpal tunnel syndrome can be treated in several ways, depending on the severity of the pain or numbness. One of the simplest treatment methods is to wear a splint while using a computer to keep the wrist straight. This reduces the pressure on the nerve.
Patients can also use medication to alleviate the pain, often with over-the-counter medications such as acetaminophen. For more severe pain, corticosteroid injections are an option.
In the most severe cases, you may need surgery to remove pressure from the nerve and alleviate pain or numbness.
Changing the routine or alleviating pressure on the nerve by repositioning your hand and wrist can prevent further issues with carpal tunnel syndrome.
If you have issues with carpal tunnel syndrome or suspect you may have it, contact Princeton Orthopaedic Associates. We can diagnose and treat your carpal tunnel syndrome. You don’t have to continue living with the numbness or pain.
There are two main categories of spinal arthritis: inflammatory arthritis and osteoarthritis. The first is caused by chronic autoimmune disorders, while the second is related to the deterioration of the joints that happens as a person gets older.
At Princeton Orthopaedic Associates, we understand both types of arthritis and have treatment options to address them.
The Basics of Spinal Arthritis
Spinal arthritis includes disease of the vertebrae in the neck (cervical) and the middle (thoracic), and the lower back (lumbar). These bones are separated by discs that serve as joints and cushion the bones. These bones can deteriorate because of chronic diseases or degeneration due to aging. This causes arthritis.
There are two major types of arthritis:
Inflammatory arthritis: This type of arthritis can affect patients of all ages and is caused by chronic autoimmune disorders. Patients report stiffness, limited mobility in the back, and pain in the neck or back. Patients often can improve by taking part in certain exercises or physical therapy. Medicine regimens have also been shown to help these patients.
Osteoarthritis: This type of arthritis more often hits older adults, as it is often caused by degeneration (wear and tear) as the person gets older. The bones along the spine wear down over time. They sometimes develop narrowed or ruptured discs, bone spurs, and cysts. Osteoarthritis is the most common form of arthritis.
Treating Arthritis in the Spine
Osteoarthritis in the lumbar spine causes pain that often radiates down through the lower body, including the pelvis, groin, buttocks, and thighs. Treatment usually involves physical therapy or specific exercises designed to strengthen your core (torso). This can include yoga, aquatic therapy, or similar strengthening exercise routines.
Patients with lumbar osteoarthritis may also go on a regimen of nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen. If the pain becomes too severe, corticosteroid injections may alleviate the pain. There is also a radiofrequency neurotomy procedure, where radio waves are used to create heat that disrupts the medial nerve’s ability to transmit pain signals.
Neck pain from osteoarthritis, called cervical spondylosis, is caused by a deterioration of the discs and joint cartilage in the cervical spine or neck bones. It’s most common in older patients, though younger people can develop cervical spondylosis. Some patients have little to no symptoms. Others may have stiffness or pain in the neck or shoulders or between the shoulder blades.
Treatment for cervical spondylosis can range from NSAIDs pain medications to corticosteroid injections. Patients may also use muscle-relaxing medication.
In severe cases of osteoarthritis, surgery may be needed to repair herniated or degenerated discs or to remove bone spurs from the spine. Recovering can take up to six months and requires physical therapy to return a proper range of motion.
Get Started With Princeton Orthopaedic Associates
Princeton Orthopaedic Associates has doctors and nursing teams dedicated to treating spinal pain due to arthritis. Our team provides exceptional diagnosis, treatment, and recovery support from your first visit to your last. We know that each patient is unique, which is why we tailor every treatment plan specifically for you and your needs.
Acute soreness in your muscles after any workout is a relatively normal phenomenon. It typically occurs with lactic acid build-up and is felt hours to a day after physical activity.
Delayed onset muscle soreness (DOMS) results after strenuous physical activity and presents as muscle soreness one to three days after exercise. This is a result of microtears in the muscle tissue resulting in inflammation in the tissue. Both phenomena are typical characteristics of muscle building as a result of increased physical activity. Both phenomena are easily treated and self-limiting with proper hydration, stretching, warm-up, warm down, and rest time.
If the soreness lasts for more than several days or becomes more intense, evaluation by a trained professional is recommended. In addition, soreness in the muscle bellies being trained is typical. Still, a more serious problem may exist when pain is located in the tendon insertions (e.g., Achilles tendon, patellar tendon, biceps tendon). If this type of pain persists or worsens, then once again, evaluation with a trained professional is recommended.
The knee is the largest joint in the body, making it vulnerable to many problems. Being aware of these problems and how to prevent them can help keep your knees healthy throughout your life, says Frederick Song, MD, an orthopedist on staff at University Medical Center at Princeton (UMCP).
Overuse injuries: In young athletes, overuse injuries are increasingly common, including patellofemoral syndrome, a dull pain caused by irritation under the knee cap. These injuries are often caused by playing the same sport year-round, weakening muscles that protect the knee. Playing different sports during different times of the year can help prevent injuries by working different muscle groups. “The number one way to treat overuse injuries is to temporarily stop playing that sport and work on a supervised strengthening program.” Dr. Song says. “It’s hard for parents and athletes to commit to stopping, but it can prevent more serious problems.”
Traumatic injuries: Sudden injuries from acute deceleration or cutting with or without contact are common in youth athletes and young- and middle-aged adults. These injuries include ligament tears and tears of the meniscus, the fibrocartilage that acts as a shock absorber between knee bones. Adults who participate in sports should also vary their activities and perform exercises to strengthen the hamstrings and quadriceps — muscles that support the knee. Keeping your core muscles strong is also essential for injury prevention. For tears, treatment usually involves surgery to remove or repair the damaged meniscus or reconstruct the ligament.
Degenerative injuries: In adults over 50, the most common knee problem is osteoarthritis, the gradual breakdown, and loss of cartilage. It’s challenging to prevent arthritis, but keeping your weight down, strengthening the muscles surrounding the knee, and focusing on low-impact exercises such as swimming and biking can help. Osteoarthritis is first treated conservatively with physical therapy and anti-inflammatory medication. Second-line treatments include injections to reduce pain or improve lubrication in the knee. “If a patient exhausts all of those treatments and continues to have pain that affects their daily activity,” Dr. Song says, “then we discuss knee replacement.”
When to see a doctor
Sudden pain and swelling due to injury should be evaluated as soon as possible. Swelling that comes on gradually, and doesn’t improve in a matter of days with rest and ice, should also be brought to your doctor’s attention.
As the largest joint in the body, the knee is one of the most easily injured.
Millions of people visit their doctor every year because of common knee problems, including fractures, ligament and cartilage tears, overuse injuries, and osteoarthritis. So how do you keep your knees strong and help protect them from injury?
Put simply, keep your muscles strong. (and keep your weight down)
Vulnerable to Injury
Your knees provide stable support for your body and allow your legs to bend and straighten. They are aided by the muscles in the front of your thigh (quadriceps) and the back of your thigh (hamstrings). Because they (are) made up of many components – bones, cartilage, ligaments, and tendons – your knees are vulnerable to various injuries.
Athletes of all ages – from the high school soccer star to the middle-aged weekend warrior – are susceptible to acute injuries like tears to the anterior cruciate ligament (ACL) and the meniscus (as well as traumatic cartilage injuries).
Additionally, athletes, particularly young athletes who (specialize) in only one sport year-round, are at high risk for overuse injuries, including:
Patellafemoral pain syndrome, which causes pain in the front of the knee.
Patellar tendonitis, inflammation of the tendon that connects the kneecap to the shin bone.
Iliotibial (IT) band syndrome, inflammation of the band of tissue that runs along the side of the thigh and knee
Further, young athletes are also at greater risk for growth plate injuries. Growth plates are areas of developing cartilage at the ends of long bones where bone growth occurs in children. When the growth plate is injured, it can fracture and disrupt average bone growth.
(Several studies have demonstrated that if a young athlete who is skeletally immature (growth plates are still open) specializes in one sport year-round, they have a 15-20x increased chance of musculoskeletal injuries compared with the same athlete that participates in multiple sports during the same period.) Simply put, young athletes should be encouraged to participate in a variety of sports up until they are more skeletally mature (15-16 years old for boys and 13-14 years old for girls).
As you age, knee problems are generally associated with osteoarthritis, resulting from wear and tear on the joint. With osteoarthritis, the protective cartilage in the knee gradually wears away, resulting in bone rubbing on bone.
According to the Centers for Disease Control and Prevention, osteoarthritis affects more than 30 million adults in the United States.
In addition to age, risk factors for osteoarthritis include:
(Traumatic) injury or overuse.
Gender, women are more likely to develop osteoarthritis than men, especially after age 50.
Being overweight or obese. Extra weight puts extra stress on the knees.
Genetics. People who have family members with osteoarthritis are at greater risk of developing osteoarthritis themselves.
Symptoms of a knee problem depend on the type of injury or condition. However, most knee problems cause pain and may limit your availability to move your knee. (Knee swelling can also indicate a structural issue.)
Diagnosing and Treating
Doctors can often diagnose knee problems with a medical history and physical exam. We may recommend x-rays and other imaging tests to confirm the problem. Treatment depends on the condition, but it involves physical therapy to strengthen the knee and the muscles surrounding it in most cases. We can usually treat tendon injuries with rest, ice, compression, and elevation. Our team may treat osteoarthritis with anti-inflammatory (medications) or cortisone (steroid) injections to reduce pain and swelling.
If knee injuries do not respond to conservative treatments, surgery may be necessary.
At the University Medical Center of Princeton (UMCP), board-certified orthopedic specialists, also experts in sports medicine, offer advanced, minimally invasive techniques to treat knee conditions.
We can often treat sports injuries (including ligament and meniscal damage) with arthroscopic surgery, a minimally invasive procedure that enables doctors to examine and repair (or reconstruct) tissues inside (the knee) through small incisions around the joint.
Protecting Your Knees
You cannot avoid some knee problems, but you can prevent many conditions by doing the following:
Warm up before playing sports. (Breaking a sweat by jogging followed) by stretching are good warm-up (strageties). Stretching the quadriceps, hamstrings, calf, and hip muscle groups helps warm up the knees. (Stretching after athletic participation is also important in for injury prevention)
Strengthen your leg muscles through exercise, conditioning and weight training. Strong thigh and leg muscles help support and protect the knees.
Cross-train. Protect your knee muscles from overuse injuriesby varying your sports. For instance, if you play basketball, try swimming for a season. If you’re a runner, hop on a bike instead.
Avoid sudden changes in the intensity of exercise and increase the force or duration of activity slowly.
Wear the proper footwear and protective gear when playing sports.
Maintain a healthy weight. Even one less pound can help take the pressure off your knees.
It is important to note that exercise, including low-impact movement, can help relieve symptoms and slow the progression even if you have osteoarthritis.
If you suffer from knee pain or injury, talk to your doctor before the condition worsens. Often, physical therapy and medication will be enough to get you back on the field or back to your normal activities in no time.
I was referred to Dr. Rossy by my general practitioner. Following surgery, I can say with measured honesty that Dr. Rossy is excellent at what he does. He is professionally personable and will answer all your questions to allay any anxiety one may have. He offers a truthful and honest opinion regarding diagnosis and surgical outcomes. Sekena, his personal assistant, is very efficient. I would highly recommend this team at POA to take genuine care of your orthopaedic needs. Thank you both and your team for the excellent care.
Diane F.
People with knee arthritis often come into the office with a common question. When is the right time to have my joint replaced? Although that varies from person to person, my answer is usually the same. When you have tried everything else, and it is bad enough, it is getting in the way of living your life." Knee replacement surgery can be an extremely effective tool to manage debilitating arthritis. It is, however, still a surgery. With all surgeries, there are risks, so we always exhaust every conservative option, and we attempt to manage those risks before ever moving forward.
The most common complaints I get in the office include joint swelling, pain in the knee, tightness, balance issues, clicking and popping, weakness, and loss of range of motion, so these are all hallmarks of progressive arthritis of the knee. These should be evaluated by an appropriate orthopedic surgeon to determine the proper steps for you. Joint arthritis should always be managed stepwise, starting with conservative treatments first. These include the following:
1. Exercise. Exercise is great for the knee joint and can improve your function and decrease your pain. You can do this on your own with directed activities or under the guidance of a skilled physical therapist. As arthritis progresses, it can cause stiffness of the joint, leading to loss of range of motion. Pain can cause you to guard and use your muscles less fluidly, resulting in weakness. Breakdown of the joint can also lead to stability issues resulting in the sensation that one may fall. Optimizing range of motion, strength, and balance can ultimately improve the feeling of your knee and delay the need for a joint replacement in the setting of knee arthritis.
2. Weight Loss. One of the most reliable strategies to improve the pain in your knee and decrease the progression of arthritis is weight loss. Every pound of bodyweight you carry is equivalent to 4 pounds of force on the joint. What does that mean? That means that 10 pounds of weight loss are like taking a 40-pound weight off your leg. That being said, weight loss can be very challenging in arthritis. It can be challenging to find a way to exercise with a painful joint. The best strategies include low-impact exercise such as walking, swimming, and bicycling. It can also be helpful to solicit the help of a registered dietician or nutrition specialist in determining the correct foods to eat. Decreasing the overall number of calories consumed daily can be a fast track to weight loss. The quickest way to do this; avoid drinking your calories. Sipping more water and tea and avoiding sugared or artificially-sweetened drinks can allow the pounds to fly off. Finally, in extreme circumstances, you may require a bariatric surgical intervention to decrease the amount of daily caloric intake and facilitate weight loss.
3. Medication. Several medicines can also be used to manage swelling and pain safely. We often recommend that over-the-counter medications be tried first. These include Tylenol (acetaminophen) and nonsteroidal anti-inflammatories (NSAIDs). These include ibuprofen, Advil, Motrin, and Aleve. You can take these drugs safely to decrease the overall amount of joint pain one is dealing with and facilitate better function. You should monitor prolonged use under the care of a physician. Please discuss this with your doctor before taking it for more than one month's time. Narcotics and illicit drugs are very rarely the answer. While these drugs can manage acute pain, they are poor medications at managing chronic pain. We strongly recommend against taking opiate pain medications to control your osteoarthritis.
4. Injections. Injections can be an excellent tool for decreasing joint pain and improving your day-to-day life. Different injections are often employed in arthritis, with other functions and durations of use. The first-line treatment is usually a steroid (cortisone) shot. Intraarticular corticosteroid injections can decrease the swelling of the joint and improve pain and function. While these are not permanent solutions, they can have a lasting effect on many people, especially mild arthritis. Viscosupplement injections (hyaluronic acid) - while these come by several names, including gel shots (chicken fat), lubricant shots, viscosupplementation injections can be a great tool to decrease their joint pain. While not a solution for everyone, these shots can be very effective and can be taken every six months to improve the overall function in the joint and decrease pain. Discuss this with your doctor.
Surgery is the last option. When conservative options have been tried and exhausted, and the pain and loss of function affect your quality of life, surgery may be the last option on your plate. The main things to do before having surgery are to get healthy. Losing bodyweight not helps decrease the pain of the joint but also speeds your recovery and improves the longevity of a joint replacement. Also, managing your chronic conditions like blood pressure issues, diabetes, and unhealthy habits such as smoking should be optimized before choosing an elective surgery, as this may decrease your chance of complications and once again improve your overall outcome.
When it is ultimately time to consider a joint replacement, a partial or total knee replacement may suit you. This should be decided with your x-rays with your treating orthopedic surgeon. In general, we use minimally-invasive techniques, avoiding damage to the knee joint muscles. Additional technologies are utilized in the appropriate scenarios, including custom-made knee instrumentation, navigation, and robotic surgery. While not necessary for all surgeries, this can be helpful in complex systems and unique cases. Finally, joint replacement has come far enough to be performed as an outpatient procedure. Young and healthy individuals with moderate-to-severe knee arthritis may be eligible candidates to complete their joint replacement and go home the same day. Please talk to your doctor about any questions regarding your knee arthritis.
Bridgewater resident Martha Barrett endured knee pain for nearly 25 years.
Then the former college gymnast met with Brian Vannozzi, MD, a board-certified orthopedic surgeon at Princeton Medical Center’s Jim Craigie Center for Joint Replacement and a partner at Princeton Orthopaedic Associates. Together they agreed on a total knee replacement. She had had nine surgeries at other facilities over the years, but nothing had helped her regain her mobility.
After the procedure Martha was ecstatic. “I have zero pain now,” she says. “I can chase my three-year-old grandson down the street. I can play tennis. Dr. Vannozzi gave me my life back.”
See Martha talk about her incredible journey in this short video – from knee pain to meeting Dr. Vannozzi to reclaiming her life:
Martha’s enthusiasm for her new life has served as an example for her friends. “I’ve recommended Princeton Health to six of my friends, and they are all thrilled.”
With results like this, it’s no wonder Penn Medicine Princeton Health was recently ranked by US News & World Report as “high performing” in knee replacement.
For more information on the Jim Craigie Center for Joint Replacement and Dr. Vannozzi call 609-924-8131
