Toes are often overlooked and underappreciated by many of us. After all, what do they do beside rub in your shoes and often get cramped?
Toes actually provide an important function during walking and as a result of that can develop problems of their own. The development of: bursa, corns, abscesses, ingrown toe nails, tendonitis, subluxations and angular deformity (Hammer Toe Syndrome) all can be produced by abnormal function of the toes.
During gait, the arch of the foot naturally depresses to help absorb shock. One of the ways that the arch tries to elevate again is accomplished is by the gripping of the toes. They help to stabilize the metatarsal heads, pull the heel bone further forward to shorten the arch and elevate the heel.
During the process of gait, if an abnormal amount of force is misdirected, (the arch being too low or the foot being too unstable) the toes must over grip and increase their actions. Often times this leads to a muscular imbalance causing deformity to the toes. Bursa and corn development occurs when a toe rubs against an object such as a shoe. The rubbing causes an irritation which in the case of a bursa develops a small fluid filled sac between the bone and the skin. This sac tries to cushion the bone, usually to no avail and with the development of further pain. In the case of a development of a corn, the irritation is to the skin. A large development of keratinized skin of the outer layer (stratum corneum) builds up to prevent further irritation of the epidermis. Of course this build up usually presses further and produces increased pain.
Ingrown nails occur as the twisted toe causes increased pressure applied to the nail groove which presses against the hard nail plate. As the hard nail plate presses against the soft skin of the nail groove irritation and laceration can occur with the development of an ingrown nail or an infected ingrown nail know as a paronychia.
Hammer Toe Deformity is the primary development of deformity of the toes. Hammer Toe occurrence is the development of an angular (twisting) position of the toe. The position of the toe causes rubbing and irritation in the shoe which produces pain.
Hammer toe deformity can be congenital (such as in clinodactyly, polydactyly and syndactyly) or developmental such as in adducto Varus deformity, flexor stabilization or flexor substution.
In the congenital development, an abnormal development of the bones, skin or insertion of the tendon has occurred which produces an abnormal position of the toe.
In the developmental development of Hammer Toe deformity, each step of an unstable foot has caused the toes to over exert themselves in trying to help stabilize the foot during gait. This produces a muscular imbalance with progressive shortening of the flexor tendons (the deforming force) and the extensor tendons (the holding force). The result is an angular mal position of the toe causing rubbing in shoes with pain.
Conservative treatment of conditions of the toes can be the use of a wider shoe, looser socks, and pads. This can be suggested by your Podiatric Physician.
Surgical treatment of Hammer toe deformity lies in the potential of producing a straight stable toe during gait and the avoidance of rubbing in shoes. This can be accomplished by reducing (lengthening) the contracted tendons and joint capsule and by removing a piece of the joint (knuckle) when prominent to allow room to straighten. Artificial joints and metal pins are some times used to help stabilize the toe during the healing period. If not sufficient enough to stabilize, then arthrodesis may be suggested.