Another reason why people get hammertoes

Another reason why people get hammertoes is they have neuromuscular problems which usually manifest as pes cavus or a very high arched foot. But as this mechanical overload occurs and it’s tendon imbalance occurs, what are some of the secondary things that happen? Well, the fat pad migrates. You can imagine if your toes go from being straight to being curled up, you start to thin out the padding under those metatarsal heads. You are pulling it distal, you are pulling it beyond the metatarsal heads, so now you don’t have the normal cushion to take the weight bearing surfaces.

Also, as your toes curl up, as the proximal phalanx in each toe extends, the first metatarsal head is effectively driven down through the bottom of the floor, again, now you’re pushing that metatarsal head out the bottom of the foot so to speak, and that hurts, and then you get the callous formation, that is the obvious manifestation of too much weight and too small an area.

So what do we need to do to treat this? Well, we need to offload the metatarsal head and this slide over here showing you some very simple things that can be done for this, they are called metatarsal pads. These have a sticky back adhesive, you can put them directly into patient’s shoes, you can send them to a shoe shop, they can do that for you as well. But the idea here and I described this as you want to make the metatarsal heads float. You don’t want the metatarsal heads to hit the ground so hard. Again, too much pressure, inflammation of the joint, the toes are curling up and it’s hurting them. So you need to get the weight bearing forces back into the arch of the foot, so this padding is placed just proximal to the heads, you can see you have different gradations of thickness here, you can sort of control the effect of how much offloading you do with those metatarsal heads. You can also have this built in to an orthotic as well as being an isolated pad that you put in the shoe, and again, appropriate shoe wear, they are going to need high, wide toe box shoes with an orthotic or metatarsal pad in order to distribute the weight bearing forces better, and they need physical therapy. Sometimes with these people with hammertoes, there can also be contracture of the Achilles tendon, so we need to stretch that Achilles tendon out a bit so they don’t overload their forefoot, they start to put weight back in their hindfoot and their heel.

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