Many consequences to bent toe | News, Sports, Jobs - Daily Mining Gazette
Let us lament the trials and tribulations of the lowly shoe. It has been blamed for so much over the years. Although they can be the source of much misery and pain, shoes protect our feet, allowing us to walk on the worst surfaces, protected from the elements and humanity's debris. Too often, they are blamed for a painful toe or an ingrown nail. How many people over the years have determined, through no scientific process whatsoever, that their bent toes are due to a pair of shoes they wore 40 years previously.
A bent toe can become an extremely painful condition, fitting poorly into your average shoe. These generally are termed hammer toes, although a host of different abnormalities can occur over time. Many complications can occur from a bent toe, but what is just as interesting is why these deformities develop.
Just so we can immediately dispel the myth, it is rarely the result of wearing shoes that are too small. Much more commonly it is the result of abnormal foot architecture. It's critical to understand that the positioning of the toes is a delicate balancing act, with a surprising number of structures essential to maintaining the alignment of each digit. Each has their exact place in the tightrope act that keeps the toes straight.
For example, when the arch rolls downward too much, the alignment of this complex arrangement is disturbed, and results in some of these structures, especially ligaments and tendons, pulling in the wrong direction. The end result is very often a buckling of the digit. Eventually, if this rolling of the arch is severe enough and/or sufficient time passes, a rigid bend develops. Alternatively, if someone's arch is too high, again, an abnormally bent toe can result.
Contracted digits, such as those discussed, have a variety of consequences, some that are not so obvious. Clearly there is going to be pressure to areas that are not adapted to withstand it. The infamous corn is one of the most common (which starts simply as a callus on a toe). Alternatively, when the toe is pulled up at the ball of the foot, the toe will push down on the metatarsal bone that it is attached to. In turn, the metatarsal is then pushed more forcefully into the ground, causing pressure to the ball of the foot. To most, it is not so obvious that the pain at the bottom of their foot is the result of the bend in the toe that has been slowly developing.
Alternatively, depending on the type of alignment abnormality, pressure to skin in the area of prominence leads to gradual but inexorable changes. Thickening of the outer layers is common, but just adds to the pressure. The nerves in the area of the bump succumb to the excess pressure, with a significant, sharp pain often resulting.
There are many ways to deal with a painful hammer toe, some of which are fairly simple. The less complex approaches are often palliative, meaning they make the sufferer more comfortable but don't fix the problem. The most common example entails the use of some type of padding or skin protection. The number of different pads that exist for cushioning and protecting a toe could fill a book (ie a catalog). Naturally, these only help if you reapply them every day. Shoe modifications used to be more practical when people wore leather shoes that could be stretched over the prominent toe.
The only "cure" is to straighten the toe, which doesn't have to be a difficult process. The most severe digital deformities require a traditional "open" technique to repair, in which a long incision is made over the structures that need to be rearranged. When less advanced, the work can be done through small openings, a concept termed minimally invasive surgery.
This idea, surgery through small incisions, causes far less trauma to the skin and soft tissues compared to an "open" procedure. This concept of small incision surgery is being developed for procedures all over the body. When used for repair of a hammer toe, it means significantly reduced recovery time, with less risk of scarring, infection, swelling or postoperative pain.
In other words, hammer toes have a solution, although which approach works best for you is a discussion to have with your foot specialist. Hammertoes can be a painful and lasting condition, but there are many different treatments available. Yes, the deformity can be corrected. Today's take-home message is simple: you don't have to live with foot or toe pain. Find the best solution for you at your local foot specialist. A responsive podiatric physician will provide information about the options appropriate. We've all heard the cliche that states 'knowledge is power.' In this case, perhaps a more precise adage would be "knowledge can equal relief!"
Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming expansion to the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.
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