As with any medical condition, early treatment is preferred. Stretching and strengthening exercises are effective for treating hammer toes only when the toe joints are still flexible. In other words if the joint can still be extended to a fully stretched position, conservative treatment is usually still possible.
To learn what different types of crooked toes look like and which variety is called a hammer toe
, visit My Toes are Crooked – Part 3: Hammertoes.
Research has found that straps worn on the toes to help keep hammertoes
straight and to cushion the toes for comfort, are beneficial. You can follow the link “Effectiveness of Splinting on Hammertoe”
to read the actual study.
Over time as the tendons shorten or contract and the cartilage on the surface between the bones is worn away, hammertoes become rigid and are not responsive to conservative therapy. At that point cushioning with gel sleeves or soft foam lined straps may protect the skin and lessen pain, but restoring motion is no longer possible.
3pp® Toe Loops® Hammertoe Regulator Gel Tube from 3-Point Products
Changing to shoes that are the proper length and that have a deeper toe box is probably the best way to slow or stop the progression of hammertoes. If this does not help, or if the deformity is fixed so the toes cannot be pulled straight, surgery is an option.
Hammertoe surgery is usually focused at rerouting the tendons that bend the toe to the top of the toe where they can help straighten it instead. This is usually done along with a joint fusion using pins or small plates to hold the toes straight. If the toes are rigid, the surgeon may also cut bone to be able to open the joint up so the toe can be fused in the proper position.
Thinking about having toes stuck straight may just be enough incentive to start tossing out those “high hell” shoes for something that provides better comfort and allows room to wiggle your toes.
Sensible does not have to look like this:
But something like this gives your toes breathing room, adheres to the rules of fashion and the need to find those perfect red slippers.
Prevention is best but when treatment is necessary discuss your hammer toes with a health care professional.
Author: Julie Belkin
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Crooked toes are not just a cosmetic concern, they can be painful and contribute to problems in the foot and ankle caused by an altered gait. The most common forms of crooked toes are:
- Claw toes that extend upwards at the metatarsophalangeal joint and then bend down at the middle and end joints.
- Mallet toes that bend down at the end joint near the toenail;
- Hammer toes where the middle joint of the toe (the PIP or proximal interphalangeal joint) bends down and the end joint (the DIP or distal interphalangeal joint) bends up;
- Curly toes where the toe bends down at all the joints.
Hammertoes are the most common deformity in the toes and the one this blog will concentrate on.
What is a Hammertoe?
Hammertoes are at least in part an imbalance of the ligaments and muscles in the toes. Wearing shoes that crowd the toes or high heeled shoes that force the toes forward into the narrowest part of the shoe can result in the toes being bent. The toes are forced to “grip” the bottom of the shoe to keep the toes from being forced to the end of the shoe.
Normally when you walk, the toes extend or straighten during the phase of gait known as “toe off”. If however the toes are crushed into a space that is too narrow or short, they may not have the room to extend and will tend to contract and bend rather than straighten. Over time this makes it difficult for the toes to straighten even when barefoot.
If in addition you have high arches or a natural tendency to keep the toes flexed, this can contribute to forming inflexible hammertoes. Some disease conditions including arthritis, diabetes, Charcot-Marie-Tooth, bunions and Morton’s toe (discussed in Part I of this blog series) also contribute to the development of hammer toes.
Can Hammertoes cause problems?
As noted in the previous blog about Morton's toe, any change in the structure of the foot that alters how pressure is distributed when walking will cause a problem. How severe the problem is depends on how severe the condition is. When the toe is in a permanently bent position, the end of the toe tends to take an excessive amount of pressure resulting in the formation of calluses that can be very painful. Additionally, the bent middle joint of the toe tends to rub against the top of the shoe causing painful corns, calluses or skin breakdown on the top of the toe. It is usually when the top of the toe starts to rub on the shoe that people decide to do something about hammertoes. Unfortunately once the deformity has progressed to this point it may be too late for conservative treatment to be effective.
Our next blog will focus on how to treat hammer toes. Look for it early next week!
As with any medical condition, early treatment of bunions is preferred as delays allow the condition to get worse and may make treatment for difficult later. Doing away with wearing shoes that have a narrow toe box or at least reducing how often those shoes are worn will help. While 4” spike heels might be all the rage right now, they are not meant for all day wear or for walking more than very short distances. Men who are not generally so adversely affected by the dictates of fashion still should examine the shoes they wear and stick with supportive oxford style shoes.
For background on what a Bunion is and what problems it can cause, please see our previous blog: My Toes are Crooked – Part 2: Bunions
“Corrective” Bunion Straps
There are numerous bunion straps and corrective devices on the market. Though some will fit in shoes, it is debatable to think that once your foot is in a shoe any strap will really offer correction. The best use of bunion straps is for nighttime wear to apply a gentle corrective stretch on the big toe in order to lessen the tightness of the soft tissue and ligaments around the toe. A light stretch that can be tolerated throughout the night is generally going to be more effective than a strong stretch that is only tolerated for an hour. At best a good bunion strap can help reduce the progression of the deformity, not permanently correct existing angulation.
Photo 1 Source: 3pp® Bunion-Aider™
Photo 2 Source: Nighttime Bunion Regulator™
Photo 3 Source: Bunion Aid® Splint
Surgery is an option for those whose bunions interfere with walking and for whom the pain affects their quality of life. The challenge with surgery is that success depends on age, the degree of angulation and the initial cause.
For those whose bunions are strongly genetically based, surgery may be less likely to offer a permanent solution. For those whose bunions were primarily caused by shoe style choice, surgery, in addition to a permanent change in shoe choice, has a better chance of long term correction.
Surgical options for hallux valgus may include rebalancing the tendons and ligaments to correct force on the toe or removing the damaged joint and fusing the joint with wire or a metal plate and screws. This is a serious step and should be considered only after a thorough evaluation by a surgeon who specializes in foot surgery.
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My Toes are Crooked – Part 2: Bunions
Crooked toes are not just a cosmetic concern. They can be painful and contribute to problems in the foot and ankle caused by an altered gait. Bunions
are the bane of many women and men due to the pain they cause and the difficulty they create in finding comfortable shoes. What is a Bunion?
The medical term for bunion is Hallux Valgus
. Hallux is the term for toe and Valgus refers to the angulation of the first metatarsal bone in your forefoot. In the classic bunion
, the end of the first metatarsal angles away from the foot causing the big toe to angle in.
The external appearance of a bunion
is a large bump on the side of the big toe with the toe angled towards the second toe. Sometimes the big toe will actually sit on top of or under the second toe.What causes a bunion?
There are three answers to this question. The first is the easiest: they can be inherited. If your mother or father has bunions
, you may as well blame it on them.
The second answer is “shoes”. Any shoe can contribute to the formation of a bunion but pointy toed high heels are the worst culprit. The less room in the toe box - the part of the shoe where your toes rest - the more pressure there is on your foot and the more that pressure is likely to cause toes to shift. Add a high narrow heel that forces the majority of your weight onto the ball of your foot and the natural mechanics of the foot are dramatically altered for the worse.
There is a reason there is a “back to barefoot” movement with products such as the fivefinger shoes from Vibram (shown below) and other similar style shoes. They purportedly allow you to walk “as nature intended”. Compared to how one walks in high heels with pressure very narrowly concentrated on the heel and the ball of the foot, there may well be something to this trend. There are of course many choices between the two extremes shown below that answer the demands of fashion without sacrificing the health of your feet. High heels do not have to be “High Hells” to allow you to look good and avoid pain and deformity.
To be fair to the fashion and footwear industries, if shoes were the only cause of bunions
, anyone who has ever worn high heels or narrow toed shoes would have bunions
. Certainly the more you wear “fashionable” shoes, the more likely you are to see the changes in your feet that lead to bunions. Shoes may or may not cause bunions but they do exacerbate problems that exist due to heredity.
Finally, the third answer is that sometimes there is no single cause and it may be a combination of factors including shoe style, heredity, injury or arthritis.Can a bunion cause problems?
Any change in the structure of the foot that alters how pressure is distributed when walking will cause a problem. How severe the problem is depends on how severe the condition is. Bunions
can certainly be painful. Not only does the shifted joint rub against shoes, the soft tissue capsule and ligaments around the joint are stretched and contribute to pain in the toe and foot.
As was noted in a previous blog post “My Toes are Crooked - Part 1”
, the normal balance of the foot means that your big toe should take anywhere from 40%-60% of the force during the “push off” phase of gait. This phase of gait occurs just as the toes of one foot are pushing off the ground and before the other foot hits the ground.
It has also been estimated that the big toe bears a force as great as two times your body weight with each step. If your big toe is angled out to the side and has lost range of motion, it cannot absorb this force nor can it properly propel you forward when you walk.
If you would like to know how bunions are treated check back for the next blog entry or simply sign up for e-mail notification in the left side bar so you don’t miss out on another informative blog.
To read in more detail about the effects wearing high heels can have not only on the foot, but the knees, hips and back read “Wearing High Heels – Effects on the Body”.You may also be interested in the following blog posts:My Toes are Crooked – Part 1: Morton’s Toe
My Toes are Crooked – Part 3: Hammer Toes (coming soon)
Author: Julie Belkin