I received a question on Twitter that I’ve heard before:
Question: “Once the 2nd toe has ‘crossed over,’ can the stretches help to avoid surgery? Would love to walk barefoot again without pain.”
The short answer is yes, but it depends on the source of the pain. The skinny is that the hammer toe and the pain may not be the same thing.
Second MTP synovitis pain is experienced in the ball of the foot. Hammer toe pain is felt on the knuckle (top of PIP joint) sticking up and hitting the top of the shoe. These are clear and different pains. And it does not require an ultrasound or MRI to tell the difference. Just a few questions and a bit of simple exam will do. The problem is we look at the foot, SEE the hammer toe sticking up and maybe crossing over and at the same time feel pain, thus they are the same problem.
True, true, maybe unrelated.
Then we see a doc and the offer to fix the “obvious” problem, the hammer toe, is made. Don’t get me wrong, hammer toes need to be fixed often, but only when they are THE PROBLEM.
The problems with this logic, actually lack of logic, are many. The hammer toe often needs no surgery, unless it is the actual source of pain at top of the knuckle. The underlying true problem is all the while missed and never addressed. I have seen my share of patients come in with a surgically corrected straight toe still in pain only because the pain was not addressed by the deformity correction. Accurate shot, wrong target!
Here is the kicker, the original inciting problem, the isolated gastrocnemius contracture can be fixed without surgery thus fixing the actual pain, the second MTP synovitis. Sometimes one must think outside the box.
I think you get it.
Stay healthy my friends,
AO
So, my 2nd metasarsal has not grown too long bending and pushing thru the plantar plate? My calves, because I have aged, are too tight? So how does one stretch out their calves? I kinda don’t think my calves are tight, but I love the idea! So much better than a bone that lengthened and needs to be shortened via surgery. So how does one stretch their calves if they don’t feel tight?
Thanks!
Hi Terre, Most of us with problems in the foot and ankle (greater than 20 in all and 65% of presenting problems in my tertiary practice) secondary to the isolated gastrocnemius contracture are unaware of calves being to tight. It is silent. You can choose to stretch, which is >95% effective, or you can have surgery for what is likely second MTP synovitis. I see approximately 300 cases of second MTP synovitis per year and I operate on the foot for it maybe 4-5 times. I am bmuch better with stretching than I am with a knife. I will send… Read more »
I unfortunately just had foot surgery, and am in complete misery. I have always had very, very muscular, large, tight calves. I would be most grateful if I could get the stretching protocol.
Hi Elizebeth,
Apologies for my tardiness. I hope the surgical result has turned around and you are doing much better. The calf stretching protocol is one of my latest blogs actually. I have been busier than a rooster in a henhouse, but I plan to be back in action from here on out. Now stop reading and start stretching.
Stay healthy my friends,
AO
I’ve been having great success with your calf stretching advice on patients! Thank you.
Hey doc,
Thanks so much for the kind words. I wish my orthopaedic friends would grab on like you have, but I would expect a chiropractor to completely understand.
Thanks again,
AO