While narrow, pointed-toe heels, black strappy platforms and booties are ranked among the top hot shoe trends for this fall by InStyle fashion magazine, many women cringe at the thought of wearing them due to their problems with painful and crooked toes. As reported in the New York Times in-depth report on foot pain, about 75% of people in the United States (and not just women) will experience foot pain at some time in their lives, and most of it is caused by shoes that do not fit properly or that force the feet into unnatural shapes (such as pointed-toe, high-heeled shoes).
Orthopedic foot and ankle surgeon Dr. Alexis E. Dixon of DISC Sports & Spine Center (“DISC”) has released a list of the top four medical diagnoses behind crooked toes and what people can do to remedy these problems.
“The type and fit of shoes do play a major role in foot and toe health, but sometimes you don’t need to look far to find a family member with similar foot problems,” says Dr. Dixon, “The good news is that many sources of pain and deformity in the toes can be managed without ever going to the operating room.”
Here are Dr. Dixon’s top four diagnoses behind crooked toes and her recommendations for treatment:
1. Bunions – A bunion is not a bump that grows, and it cannot be shaved off! It occurs when the great toe starts to angle towards the second toe, most commonly because of narrow shoe wear. This, in turn, causes the great toe’s bone in the foot (or metatarsal bone) to angle the opposite way, making it more prominent on the inner border of the foot.
Once a bunion occurs, wearing wider shoes or open-toed shoes may make the discomfort more manageable, but surgery is the only way to correct the deformity. If you are having a significant amount of pain that is inhibiting your ability to do the things you love to do, or you have difficulty with all shoe wear, you should definitely get your feet checked out. Surgery is rarely urgent, but it is more complex than simply shaving off the bump, since—as noted above—bunions do not represent excessive growth of the bone. Adequate correction requires cutting and re-setting bones into a better position, so you have to plan for adequate recovery time. Many patients prefer to have the surgery done in the winter so that they can wear open-toed shoes by spring.
2. Bunionettes – Similar to bunions, bunionettes are a prominence of the fifth toe at the outer border of the foot. Treatment is very similar to that of a bunion, which begins with first wearing wider shoes until symptoms are no longer tolerable. Surgery rarely allows for simple shaving off of the bump because, again, this is an angular deformity of two bones, and the bones have to be straightened to correct the angle.
3. Hammertoes – A hammertoe is deformity of one or more of the smaller or lesser toes that happens most often due tight shoe wear, but is sometimes related muscle imbalance or inflammatory arthritis. First, the toe begins to stick up, then the toe begins to form a Z-shape at the next joint. This prominence can cause the skin on top of the toe to rub against the shoe, and can lead to painful calluses at the ball of the foot.
The first step in treatment is avoiding shoes that bother the toes. There are shoe inserts that can cushion the ball of the foot if that’s where pain is, and there are toe spacers that can alleviate pressure. However, sometimes hammertoes can become so severe that even shoe wear modification is ineffective. In this case, outpatient surgery can be used to straighten the toes. Different implants may also be used but are usually either screws that are completely internal or pins that protrude through the skin and are removed in office, usually one visit after the stitches are removed.
After hammertoe surgery, the toes are much straighter, and often even straighter than they were before the hammertoe developed. This is because one of the joints in the toe needs to be fused in order to correct the deformity and prevent recurrence. The goal of surgery is to alleviate the pain, but patients usually find improvement in appearance of their feet after surgery as well.
4. Hallux Rigidus – This is another term for arthritis in the joint at the base of the great toe. When a patient has hallux rigidus, the body responds by laying down new bone, or an osteophyte, at the top of the toe. The formation of new bone can lead to a bump that is painful when rubbed against the shoe. Some patients complain about stiffness and pain at the bump, while other patients experience pain from the arthritis itself.
When the bump is painful due to pressure, outpatient surgery can be performed to remove it from the top of the foot. The surgeon will usually also look inside the joint and see if there is any debris that can be removed to alleviate the pain. A newly developed surgery actually places a cartilage graft within the joint—an exciting new way to resurface the damaged cartilage.
Sometimes a patient’s arthritis is so severe that there is virtually no cartilage left, and any motion in the joint is painful. The first step in treating pain with any range of motion of the joint is to wear stiffer shoes so that the joint is protected from motion. This can be done by either purchasing shoes with stiff soles, or by placing carbon fiber inserts into the shoes, which can be prescribed by your surgeon.
If the severe arthritis pain persists, the patient’s surgeon may perform a fusion of that joint, which allows the two bones to heal together as one and relieves the pain. This can be done as an outpatient surgery and is typically an excellent option for men, as well as women who do not wear very high heels. Wearing high heels after a surgery like this can be difficult, so Dr. Dixon typically doesn’t recommend this procedure for women who would like to continue to sport this particular fashion.
Dr. Dixon also cautions patients that pain at the ball of the foot is often mistaken for a Morton’s neuroma, which is an irritation and scarring of the sensory nerve to the toes. While Morton’s neuromas do exist and can cause forefoot pain, there are other, more subtle, diagnoses that can also be the cause of pain in this area of the foot. She recommends against repeated injections for Morton’s neuroma, stating, “These can erode away at the fat pad that cushions the bottom of your foot, leading to chronic pain that is difficult to reverse.”