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Toe Woes - what goes wrong with feet

Stay a step ahead of clients' needs by learning to recognize the most common woes that may cause pain and disfigurement to clients' toes.

Smash Hammertoe Habits

The feel of sand between the toes, fresh grass under the feet — many tactile sensations can cause the toes to curl with pleasure. But when the curling is contracture of the toe response to illfitted shoes or a foot disorder and becomes a long-term habit, the condition is called hammertoe or claw toes (depending on which toe joint is involved and the direction of the contracture).

The contracture is typically a result of a muscle imbalance between the tendons on the top of the toe and the ones on the bottom.“Hammertoe is the general term used to describe an abnormal contraction or ‘buckling’ of the toe because of a partial or complete dislocation of one of the joints of the toe or the joint where the toe joins with the rest of the foot,” says Richard Allen, D.P.M., a podiatrist in Lewiston, Ohio. “As the toe becomes deformed, it rubs against the shoe and the irritation causes the body to build thicker skin to help protect the area.”

According to Dr. Allen, a deformity in the joint nearest the nail is called a mallet toe, while a deformity in the joint where the toe meets the foot is called a hammertoe.Deformities in both joints, on the other hand, result in what’s called a claw toe. Regardless of which joint is involved, the toe contracture results from muscle imbalances that cause the tendons and ligaments in the affected joint to tighten and shorten, which in turn bends the toe.

According to podiatrists at The Walking Clinic in Colorado Springs, Colo., the important distinction in toe contractures is whether the toe is flexible or rigid. Initially, contracted toes can be straightened (hence the term “flexible”), but over time tendons and muscles in the toe permanently shorten and the joint freezes, making the contraction permanent and the toe rigid.

While flexible contractures can be relatively painless — except when corns form in response to friction from shoes — rigid hammertoes can restrict foot movement and cause pain in the foot as well as potentially cause other imbalances that lead to additional disorders.

While the toe is still flexible, hammertoes are relatively easy to correct. For example, the doctors at The Walking Clinic regularly release the tendons from the bone, a fast surgery done via a tiny incision in just minutes. The patient has only a local anesthetic and walks out of the office with little more than a bandage to mark the operation. Rigid contractures, on the other hand, require a more invasive surgery to remove the joint or fuse the bones. While these procedures straighten the toe, podiatrists emphasize that the rigid toes can cause pain while walking and may even negatively affect the walking pattern.

To minimize the risk of forming hammertoes, Dr. Allen recommends women ensure their stockings don’t constrict their toes and cause them to contract. Avoid high heels, as well, which tend to jam toes into the front of the shoe and cause the tendons to contract. Treat the corns that are a common result of hammertoes the same as advised for bunions, and use a light hand around affected toes when massaging. Refer clients to a podiatrist for treatment, urging them to seek help before the joint freezes.

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