Hate Looking At Your Feet? Part 1: Hammertoes



So you don’t like the way your foot or feet look? Hammertoes, claw toes, and, even to some degree, mallet toes are a by-product of the way we use our feet/body and the environment we give our feet to live in. We shove these poor feet into tight shoes, narrow close-toed heels, sandals and thonged footwear (which are more likely to cause bunions than hammertoes). Also, the way we walk and our weaknesses in other body parts can cause some not very appealing feet.



The mechanics of the foot are a complex system of bones that enable us to propel to do so many fantastic things with our bodies. We could delve into an encyclopedia's worth of information if we want to get deep, but to avoid losing you we will have a shortened version.


So how do you know if you have hammertoes or claw toes?


Symptoms include:

  • Visually looks off

  • Unable to straighten toes

  • Callouses on toe/toes

  • Bloody toenails or swelling in the affected toe

  • Pain when walking

  • Painful to the touch

  • Irritated in tight or cramped shoes/heels


Causes:


The five little toesies we have on each foot are meant to splay forward and out about a quarter to a half an inch. That's why it's important for your shoe to allow for your foot to expand when you put your weight down. We typically recommend getting a shoe that is a half size bigger to allow for this.


The structure of the foot has tendons and muscles that closely resemble a tent-like structure. The bones are creating somewhat of a springy pyramid-like foundation for what we commonly know as our arches. The moment our body weight shifts forward, the support of our feet should as well. This is why your toes splay when shifting.


So the top-secret reason our toes get bent downward and inward if our shoes are too tight is that the active contraction of the intrinsic foot muscles pictured below will get tighter and tighter, forcing the toes to deform. Now if this is done repetitively over a long period of time, you can imagine how this could affect your feet. When we wear inadequate or tight footwear, other structures in the foot can start changing as well.

Image from: https://bjsm.bmj.com/content/49/5/290.full

Image Modified from Levin & O ́Neal 2008. Right images courtesy from Ramos F, MD)


So how can you fix it?


Believe it or not, podiatrists (healthcare professionals who specialize in feet) often would recommend some passive stretching and changing your footwear or to try products like the one pictured below, but this is rarely effective.

If you keep going back to the podiatrist complaining of the same thing, they will often then recommend surgery. I have provided detail fro a local center about their surgery options to treat hammertoes. It's enough to freak me out and I would be willing to try anything but this! But I will let you all decide for yourselves.


The following is from the website of the Orange County Foot and Ankle Surgery. This is what they recommend.



What does hammer toe surgery entail?


If your hammer toe deformity treatment requires surgery, the procedure will be done on an outpatient basis. The exact technique that is used during the surgery will depend on your situation, but some of the most common methods include:


Joint resection – This method is used for hammer toe that is stiff. An incision is made over the top of the toe, and then the ligaments and tendons are usually cut to make straightening the toe easier. Pins may be used to make the toe straight and the end of the bones may be removed.

Fusion – Another method for stiff hammer toe, this is similar to joint resection and involves the use of screws or pins to keep the toe straight while the cut bone heals.


Tendon transfer – This method is used for flexible hammer toe. In this procedure, your tendons will be rerouted from the bottom of your foot to the top of the toe in order to pull the joint straight”.



Doesn't that all sound awesome?? In cases that are super severe and unbearable, if you've tried every solution possible, surgery might be necessary. But we do always preach here at Rehab and Revive that nothing is usually better than the original parts, and most of the time we believe we can help!


Hopefully, you can avoid surgery with good old fashioned gait education, DIY exercises and habit changes. Below are a few suggestions from us that may be able to help you avoid pain, surgery and get you feet that you enjoy looking at!


1. Life's too short to be uncomfortable: wear shoes that fit and allow splaying of the toes



2. Keep the muscles in your feet strong and stable



3. Keep the joints aligned in your lower body and don't ignore any changes in your feet. You may need to get it addressed right away with manual therapy.



4. Change the way you walk and promote more splaying in your toes and feet



5. You may want to try re-education techniques such as taping to actively retrain those intrinsic muscles and keep your toes looking healthy and straight!



If you find yourself suffering from these symptoms, ask a healthcare professional what you can be doing to rehab and revive those feet!




Heal smarter, not harder,


Dr. Justin C. Lin

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