Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Corns are more likely to develop as time goes on--and corns never really go away, even after trimming. In more severe cases of hammertoe, open sores may form.

It is still not known exactly how leprosy is transmitted from one person to another. It is believed that the disease is spread through respiratory droplets but this has not been proven. Preventing the spread of Hansen's disease is, for the present, limited to treating individuals after they contract the disease. Some of the vaccines used to treat tuberculosis may offer some hope in this area since the bacteria that cause Hansen's disease are similar to those that cause tuberculosis.

Hansen's disease was once a widespread disease but is now generally classified as a tropical disease, with the larger numbers of cases concentrated in Brazil, India, Nigeria, Indonesia, Bangladesh and Myanmar. Only about five percent of the people who are infected with the bacteria actually develop the disease. The immune system generally prevent the development of leprosy. However, it has been found that some people are naturally more susceptible to the infection, while others carry a natural immunity. When an individual does develop symptoms, they are usually mild. The disease is only fatal in rare cases or in cases where other complications have taken hold.

Hansen disease is caused by a bacillus, Mycobacterium leprae, first described by G. Amauer Hansen, MD, of Norway in 1874, that multiplies very slowly and mainly affects the skin, nerves, and mucous membranes. They have a predilection for the cooler areas of the body. This acid-fast rod has never been grown on artificial media or tissue culture, but, in 1960, Shepard successfully grew M leprae bacilli in mouse foot pads. Studies have shown that solid staining bacilli were infectious to mice, while beaded were not.

The good news is that Hansen's disease is curable. In 1981, the World Health Organization recommended the use of a combination of three antibiotics--dapsone, rifampin, and clofazimine--for treatment, which takes six months to a year or more. During the course of treatment, the body may react to the dead bacteria with pain and swelling in the skin and nerves. This is treated with pain medication, prednisone, or thalidomide (under special conditions).

Compiled statistics reveal that Hansen's disease (leprosy) is rare in the U.S. There are currently approximately 6,500 cases; about 3,300 require active medical management. People with Hansen's disease (leprosy) can generally continue their normal work and other activities uninterrupted while they are under treatment, which may last several years. Yet Hansen's disease (leprosy) remains the most misunderstood human infectious disease. The stigma long associated with the disease still exists in most of the world and the psychological and social effects may be more difficult to deal with than the actual physical illness.

Hansen's disease has very characteristic clinical features but the diagnosis must be confirmed because of the need for prolonged treatment with antibiotics. A skin biopsy may show characteristic granulomas (mixed inflammatory cell infiltrate in the deeper layers of the skin, the dermis) and involvement of the nerves. Special staining of the tissue may show acid fast bacilli, the number visible depending on the type of leprosy.

The bacteria may also be found in lepromatous leprosy on smears taken from skin slits made in the ear lobes, but the smears will be negative in the tuberculoid or borderline forms of the disease.


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