Do tight shoes cause hammertoes?

hammer toe

I am often asked this question, and see it improperly discussed online and even by medical professionals.  The simple answer is that tight shoes are not the cause of hammertoes, despite popular belief.  Hammertoes, which is a term often used to describe a plethora of conditions in which the toes curl up or rotate, have numerous causes that usually start with abnormal foot structure and imbalance between muscles that pull the toe up and those that pull the toe down.  This imbalance, caused by abnormal muscle pulling that develops from having feet that are structurally closer to extremes of being flat or high arched, forces the toes to curl downward in various ways.  Shoes do not influence the position of the toes and cannot ‘force’ the toes downward, although poorly fitting shoes can irritate the skin and joints of toes made more prominent by the curling.

What causes the bump on top of my big toe joint?

hallux limitus

In this post I will discuss the ‘bump’ some people have on top of their big toe joint.  Many people are aware of the bump some people have along side of the big toe joint, as it goes by the name of a ‘bunion’. What is less known is the cause and treatment of a bump on top of the big toe joint, which is something somewhat different than a bunion.

Firstly, I would like to apologize for taking so long in between posts this past month.  In between very long days in the office, as well as more recently a number of hours spent helping coach my son’s football team, my spare time to post has been limited.  Now that I have more time, I can continue to post articles I hope everyone finds informative.

Back to the topic at hand.  As I wrote above, the cause and treatment of a bump on top of the big toe joint is different than what is traditionally known as a bunion.  Not to confuse things further, but this condition is commonly called a dorsal bunion by physicians, and can actually be seen with a traditional bunion at the same time. However, it’s cause really is from a somewhat different process than the traditional bunion (see the other bunion article on my site for a more detailed explanation of a bunion).

The bump commonly felt on top of the big toe joint is usually due to jamming of that joint from an arthritic process. Arthritis of the big toe joint develops over time due to a number of reasons. Usually, there is some structural abnormality in the base of that joint that allows excessive and premature wear and tear of the joint cartilage. This can include a bone that is too long, too short, angled too high, or angled too low. The motion of the big toe joint becomes reduced over time due to this wear. The reduction in motion of the joint and excessive compression force on top of the joint from it trying to force lost motion causes bone spurring to form. This usually occurs on top of the head of the 1st metatarsal, which is the long bone that forms the base of the big toe joint. The spurs become painful as inflammation develops in the joint below, and also in the tissue that covers the spurs above. What is felt externally is the painful enlargement of the spur below, which is also irritated by pressure from shoes.

Treatment of this condition usually involves surgery, although a steroid injection or anti-inflammatory medication can provide temporary relief. The surgery can be as simple as shaving the spurs down. Unfortunately, this does not correct the underlying structural problem and over time the spurs can reform. What is often needed is a procedure that alters the abnormal bone position, decompresses the joint, and repairs the joint arthritis. There are numerous procedures that accomplish this. Some severe cases of arthritis need a procedure that replaces the joint with an artificial one, or fuses it all together.

What Can Be Done About A Thick and Painful Toenail?

thick toenails

Many people are surprised to find out that toenails are relatively fragile appendages of the body. Toenails can take a mild amount of abuse from tight shoe pressure, years of toe stubbing or objects dropping on them, damage from jogging and exercise, or changes due to chronic fungus infections. Over time though, the nail root cells that produce the nail plate itself will become damaged, and they will begin to permanently produce nail that is thick, deformed, often painful, and even severely ingrown on one or both sides. As a result, many people find themselves with one or several toenails that hurt with shoe pressure, or anything pushing on the nail (like bed sheets). Unfortunately, these changes are permanent. In the case of nail fungus, it is assumed medication can ‘cure’ the disease. While it is true anti fungal medication can kill fungus in some cases, once the nail reaches a certain point of damage, there is no restoring the nail back to normal.

Treating these painful and deformed nails can be fairly simple. There are topical medications designed to soften the nail and help make it thinner, but unfortunately these typically are ineffective on thicker toenails, and treatment has to be performed for life. A pedicurist or podiatrist can grind the nails down to make them thinner, but this has to be repeated frequently as such nails typically thicken again within a couple of months. A better, and more permanent, option is to simply remove the toenail for good. Many people seem initially put off by the concept of this procedure. Once one realizes the ease of the procedure and its recovery, the fact that under the nail is normal skin that is not cosmetically disfigured without the nail on top, and the fact that there will be no further pain from the nail, the procedure itself becomes a sensible and preferred option.

Removing a toenail is not difficult matter, and for most people the procedure is relatively painless outside of the brief discomfort of the shot needed to numb the toe. The entire procedure including the numbing period is performed in under 15 minutes in an office setting. Once the toe is numb, the problematic nail is easily removed and a chemical is used to kill the nail root cells so no more nail is ever produced in that toe. Called a ‘phenol matrixectomy’, this procedure has been performed for about a hundred years and has great results. The recovery is brief, usually lasting 2-3 weeks and there is no restrictions on activity or shoe use. Most people have no discomfort during recovery, and go about their normal day unaffected by the procedure. The nail bed skin that remains on top of the toe can even be polished to match intact toenails next to it, with no one being the wiser that the nail is gone.

Such a procedure is perfect for those with one or a few painful deformed nails, and is nearly always covered by insurance. I have performed many thousands of these procedures. In nearly every case my patients have confided with me they wished they knew it would have been that easy to get relief years earlier, as they would not have otherwise suffered with a painful nail for so long.

If you have this same problem, be sure to call your local podiatrist to discuss how removing the painful and deformed toenail permanently can lead to relief.

Do Broken Toes Really Need Medical Attention?

toe fracture

One of the most common foot injuries is the toe fracture.  This seemingly minor injury can be the source of much pain and annoyance, and often hails from a midnight misadventure to the bathroom as a dresser suddenly lurches in the way of the unsuspecting sleepy victim.  The common assumption is that there is nothing that can be done for a toe fracture, so why bother to have it addressed?

My response to this is that if it were a finger, would one not seek medical attention?  Yes, I realize toes and fingers serve two very different purposes.  However, the anatomy of the injuries is generally the same, and the severity of not addressing these injuries in a timely manner could be equally problematic.

Toe fractures can run the gamut of simple clean breaks, all the way to displaced fractures that stick out away from the intact bone.  Clean breaks are simply treated with buddy splinting of the injured toe to the next toe, and the use of a stiff soled shoe.  However, there is no external indication as to whether a toe fracture is a clean break or if it is shifted out of position, and the level of pain or swelling associated with the injury does not offer a true clue either.  X-rays and medical attention are needed to determine this, as a decision has to be made as to what needs to be done to put the toe bone back into place and keep it there while it heals.  This may be as simple as manually distracting the toe to put the fracture in place with the use of splints to keep it there, or, in serious cases, treatment may require surgery to repair and secure the broken bone.  The danger of the bone not setting right comes in the form of future issues with the toe, which includes new areas of prominence from the displaced and malformed bone that may rub in shoes and cause sores (a particular danger for diabetics), long term pain from a non-healing fracture, or long term arthritis if one of the joint surfaces in the toe was disrupted by the separated fracture.

Ignoring a toe fracture could prove costly, as some non-healed fractures require additional surgery to remove the fractured bone end in an effort to end pain.  A simple visit to a physician, preferably a foot specialist (who by nature deals with toe fractures on a regular basis), can ensure that this nagging injury heals properly, quickly, and without long term consequence.