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 the protocol by separate email. Do it everyday, you won’t be sorry.
Stay healthy my friends,
AO
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
Hello, the podiatrist just told me I have hammertoe -my second toe on both feet have a hump on the joint -so far the only pain is certain shoes may rub. Are there exercises I can do to correct this or to stop it from getting far worse? My podiatrist didn’t offer anything, I was actually there for a different foot injury and he just mentioned I have hammertoe. I started researching it once I got home it seems there should be some exercises to help lengthen those muscles. Thank you for your time!
Hi Sue,
Good history. The root cause of your hammertoe is equinus and you need to start calf stretching you want to arrest any progress. Please see my on second MTP synovitis, part one and part two. I don’t usually ask a patient to stretch their toe only because few would be constant enough to make a difference. Having said that I have had a few who succeeded when the deformity was minimal. So, what do you have to loose. I would push down on your toe for 1-3 minutes at lease 2-3 times a day. You could do it watching TV, or anytime you are sitting. The anatomic point to press on is officially on the top of your toe at the distal end of the proximal phalanx. This is just on the ankle side of your toe from the joint hump (not on the side towards your toenail). The key is doing it every day and for months if not forever. But, don’t forget to stretch those calves.
Stay healthy my friends,
AO
I would love your take on my problem. My problem seems to have started November 2018 when I went Christmas shopping for 3 days wearing a pair of wedge ankle boots( first time that season) that had never given me any problems. Both feet generally hurt all over afterwards, but the holidays were approaching and I thought they would get better. In Jan. I had sharp pain on top of my feet, burning, tingling and cramping mostly at forefront of feet. The sharp pain did go away within a week. I went to a podiatrist and he told me my shoes were too small and narrow for my feet and to soak them in cold water and then heat. And buy wider shoes. A few months later I went to my MD who told me I had idiopathic neuropathy and gave me Gabapentin. After reading the side effects I did not take it. My main issue at this point was ball of foot pain when walking and tingling. I went back to the podiatrist who told me the Birkenstock’s I was wearing were bad for my feet. They were too hard and I needed cushiony shoes. So I bought more shoes. 3 months later I was back at my MD and he convinced me to try the Gabapentin. BTW, I’ve never been convinced I have neuropathy. But I tried the drug for 3 months and it didn’t help. So I stopped it. A friend recommended stopping the Gabapentin snd try the supplement R-Lipoic acid.
6 months later I was still having the ball of foot pain when walking on hard surfaces, numbness and stiffness in toe joint area when I wiggle my toes. Maybe like duct tape stuck underneath. Just a strange hard to describe feeling. So I tried a different podiatrist. He did a thorough exam. I didn’t have any pain in the toe area at his exam, but I did have near my heels. He started treating me for plantar fasciitis. I thought that might also fixed my forefront feet. After 5 weeks, the PF was much better and he wanted to fit me in custom orthotics. The issues at the front of my feet were still there. When I questioned him he said “oh you have hammertoes and there’s not much you can do about it”. I did not get the custom orthotics and left upset that he had not helped the original problem to begin with. To look at my feet you don’t see a hammertoe or crossed toes. I went to my chiropractor, the only dr. I trust at this point. He didn’t see hammertoes either but he did see callouses on the sides of my inner and outer feet. So possible the beginning of hammertoes from too narrow shoes.
One year later and I still have the problem. I went back to the first podiatrist and he said I had a pinched nerve. Put metatarsal pads in my insoles. Said I might should see a neurologist. Decided to go back to my chiropractor. He’s been adjusting my back and feet for a few weeks. Seems a little better. He has referred me to a neurologist so we’ll see. The stinging and tingling seem better but the stiffness in my toes are still there. BTw, my toes are completely flexible just feel stiff. I have also started wearing open toed sandals which seems to help take pressure off my toes.
I don’t know where to go from here.
Hey Mary,
It seems you are getting the usual run around. People guessing with confidence, pity. So, I will keep this short. Maybe your issue has never been fixed because the root cause has never been treated. That root cause sounds to me like equinus, or calves that are too tight. This silent biomechanical issue is very common and is the cause the majority of non-traumatic acquired foot and ankle pathology. You heard it here and basically no one else will tell you that. My answer is quite simple, Stretch your calves!
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