Hammer Time

A fairly common accessory to most post-club feet is the hammer toe, and the claw toe. As both cause the top of the second phalangeal joint to press against the inside of the top of the shoe, the eventual results are callouses, corns, and blisters, oh, my! There are, as you might imagine, numerous approaches to relieving the pain these little beasties can cause, from chemical, to surgical, to mechanical. Let's take a look, shall we?

Corns are those especially resilient little meanies that have a "core" to them. That is, they grow outward from near the bone, well below the epidermal layers. This makes them especially difficult to get any long-term relief from without resorting to unconventional warfare. There are many so-called corn removal systems, some of which work better on some people, but not so well on others. It's pretty much a try 'em out for yourself situation. One of the problems with the chemical solutions is the need for constant repeat applications, much of which just gets rubbed off the surface of the corn as soon as you put your sox on.

There are of course surgeries to straighten toes out, but here again, these surgeries work in some cases, and not so much in others. Despite what doctors like to tell their patients, the fact is that each of us has our own unique way of responding to such surgeries. I don't advocate against them, but just know the outcome may not be what it's sold as. Certainly where the hammering is very extreme, surgery will offer at least some percentage of relief. But where there is less rigidity of the deformity, there are other approaches to consider first.

Whether corns, callouses, or blisters (which are usually merely a precursor to a callous,) the other factor at work in promoting the growth of either is pressure - shoe pressure, of course. When the deformed digit raises the toe/toes, they have a greater propensity to encounter shoe pressure merely because they are raised higher than adjacent toes. But there is another factor at work here - the pathomechanical action of the toes during the various phases of gait. This is especially the case where there has been an anterior tibialis transfer, as the toes are used to assist the front of the foot with dorsiflexion, that is, picking up the front of the foot as the toes leave the ground during the toe-off phase of gait. This action is necessary to prevent the toes from dragging, and to position the rest of the foot to prepare for the heel to strike the ground on it's next heel strike.

The result is what is known as extensor substitution - using a different set of extensor-group muscles to provide the motion either impaired or lost to the group normally assigned this particular task. We can observe this directly with people with multiple sclerosis - they have difficulty with their entire lower extremity anterior muscle group, and the one way they can get their feet off the ground is by using muscles all the way up in the hip and pelvis to do the job. So when the toes are made to do the job of dorsiflexion of the foot on the ankle, their superior, or top group of muscles and tendons get a real workout, far more so than their inferior, or bottom group does. This overpowers the inferior group, and hammering or clawing are an inevitable result.

There are two distinct mechanical responses that can offer near-immediate relief from shoe pressure, however. The first, and certainly most obvious, is to stretch the area directly over the offending digit. Here is a youtube video that offers some help on how to do this yourself:






Now, this video only shows you stretchers that are used to stretch the width of the shoes. There are other devived that stretch the height, and these open at the sides instead of at the top, as the video shows. So it's important you get the right kind. And those little bump attachments? Very important to getting targeted stretching in the right place.

The best and easiest tool to use for stretching the top of the shoe without affecting any other part of the shoe is to use a ball and ring stretcher: See this web page as an example (not affiliated with this site, nor receive any considerations from same.) The trick to stretching a shoe is quite easy - you need three things - the stretching tool, stretching fluid, and a shoe material that is in fact stretchable. Many man-made materials offer little or no stretching potential, whereas leather uppers are always a good bet. As for the stretching fluid - you can buy some, or, you can easily and cheaply make your own. Merely mix 50% water with 50% rubbing alcohol. Apply liberally over the top of the shoe. I suggest applying it over the entire area, so as to prevent a stain, that is, the edges of the fluid applied to the shoe may remain visible, so by applying it over-all, this seldom will occur. Rub the fluid into the material, then apply the stretcher you've chosen. If using the ball and ring stretcher, you can either set the clamping mechanism and walk away, or "walk" the stretcher over the broader area to prevent the appearance of a "bubble" raising the top of your shoe. It may take several applications of stretching to make the change permanent - many materials, even leather, has some level of elasticity, and wants to return to it's original shape. So be persistent. Because one other thing to consider with stretching - this reduces or removes the pressure over the offending area, and thus reduces the need or at least the frequency for future chemical assaults.

The second mechanical approach is to both stretch, and add rocker soles to your shoes. The rocker sole reduces the need for extensor substitution by helping supply that motion to the foot during gate. No, it doesn't change the muscular dynamics at play, but it makes the need for those dynamics reduce, sometimes by a significant amount. If the foot is achieving what it needs to during toe-off, then the compensatory actions of the toes are less needed.

Finally, if you intend on using chemical means to pair down the callous or corn, consider first soaking your foot/feet in warm water with epsom salts, to get the skin as soft as possible, then using a callous blade to remove as much of the hardened tissue as possible, before applying your chemical warfare. You'll get better long-term results, as the chosen chemical agent will be better able to get down closer to the root of the "problem."

For more info on this, visit here. The most important thing is, be consistent with whatever approach you use - you'll have much better results. For even better results, consider seeing your local podiatrist to get the whole process started. They have the knowledge for both diagnosing and treating, which is especially important with differentiating between a corn and a callous - critical to taking the right approach with direct treatment protocols.

And don't forget the bottom of the toe/s! The toe lifts at the second joint, but also drives the first (end of the toe) into the sole of the shoe, so you will also have to consider adding a depression in the shoe insert or the forefoot extension of the orthotics you have. In very extreme cases, I have had to use a dremel tool to carve into the shoes insole to provide this relief. 

Oh, and whatever you do, don't take that old Three Stooges approach. Don't try using another hammer on the problem:-)