Dear Dr. Roach: What is the cause of and treatment for hammertoe?
A.
Hammertoes have many possible causes, including a variety of muscle and nerve diseases, but the biggest cause I see is improperly fitted (or designed) shoes.
They occur most commonly in the second, third or fourth toe. Toes are permanently bent and curled, resembling a hammer.
Once the hammertoe process begins, toes need treatment, as they don’t get better and are likely to get worse without it. Conservative treatment includes proper footwear and sometimes, physical therapy.
More severe cases require surgical procedures, of which there are many.
One person wrote to me about a tendon-snipping procedure that was a great success for her, but only a qualified foot specialist, such as a podiatrist, can recommend treatment.
Dear Dr. Roach: I had a recent valve replacement with a mechanical valve. A really unexpected effect has been on my hemochromatosis, which used to require the removal of four to six pints of blood every year. Now it seems to have dissipated, as my iron levels have been stable since the surgery. My primary-care physician suspects that the valve is causing higher turnover of red cells, thus using up excess iron. Any other thoughts to explain this?
M.S.
A mechanical heart valve, no matter how advanced, does still increase the rate of damage to red blood cells, causing them to be turned over, as your doctor says.
They are being destroyed in the spleen and liver, and new ones are being made in the bone marrow. However, the iron in the blood cells is recycled; there is no net loss of iron.
People with primary or genetic hemochromatosis absorb too much iron. The treatment is iron removal. I would be concerned that since you no longer need iron to be removed by bloodletting, you are losing iron someplace else, and the most common place, by far, for that is through the colon.
While polyps and cancer are the most concerning causes of blood loss through the colon, one other consideration is arterio-venous malformations.
These are abnormal direct connections between arteries and arterioles (high-pressure oxygenated blood vessels) and low-pressure deoxygenated veins. These have a tendency to bleed, and are found more frequently in people with aortic stenosis, where the aortic valve doesn’t open properly. Since even the best artificial valves are never as good as native valves, there is some degree of stenosis with even a perfectly working mechanical valve.
I would suggest that you discuss getting a colonoscopy with your primary doctor.
Dr. Roach Writes: A recent column on jackhammer esophagus generated a surprising amount of comments.
Readers wrote in that treatment of GERD solved their problem. However, the most common advice I received was to take sips of warm water, which helped many people with their symptoms.
Unfortunately, that advice doesn’t help everybody, and considerably more powerful treatments are required for some. One woman wrote to tell me that because her symptoms were so severe, she had been recommended for surgical removal of her esophagus, which I had never heard of. She wrote to let my readers who suffer from the most severe forms of this condition know that they are not alone. Thanks to K.G. and the other readers who wrote in.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
