Toes are crucial for maintaining balance; without them, we would stumble and rely on our hands to maintain whatever little balance we could achieve. Therefore, when something goes wrong, or their position is incorrect, various difficulties related to these issues can arise. If our toes are not functioning properly, footwear becomes a problem, causing discomfort and leading to structural issues in our feet.
1. Clinodactyly or "Overlapping toes"
Overlapping toes are not often discussed but are more common than we think, and there are ways to treat them if desired.
This is a malformation in the foot muscles that results in incorrect alignment of the affected toe. It can be congenital or acquired, meaning it can be present at birth or develop due to trauma to the tendons or bones of the toe. Clinodactyly is often seen in the second toe, where there is stretching of the extensor muscles and joint ligaments, sometimes leading to dislocations.
The affected person often has calluses from abnormal friction and even hypertrophic nails (excessive nail growth, especially on the toes, with thick or irregularly shaped nails) due to mechanical trauma, which can interfere with walking.
Symptoms
Visually, the overlapping of the toes is easy to detect, with a loss of space between the first and second toes, which also predisposes them to Hallux Valgus (bunions). It causes friction on the top of the toe, leading to painful calluses, and the third toe may become crushed, which could even change the shape of the nail.
How to treat Clinodactyly
The treatment depends on how advanced the deformity is. Sometimes, it doesn't affect the physiological function of the foot and allows for a relatively "normal" step, being a minor deformity. However, in more severe cases, overlapping toes can alter the gait and cause postural abnormalities, which could later lead to joint problems in the knees and hips.
In severe cases, surgery is the only alternative, using techniques such as Z-plasty and tendonotomy, along with tendon lengthening (tendon elongation).
Conservative treatment for Clinodactyly involves positioning the toes correctly within the foot's anatomy using toe separators, along with proper footwear that provides enough space for the foot and toes so that muscle memory can align them without pressure.
Toe separators are important because they fix the toes in their proper position and protect them from calluses caused by friction from the deformed toes, preventing irritation that could worsen the foot issues.
2. Claw toes
Claw toes are a fairly common deformity of the toes, except for the big toe. This occurs because the metatarsophalangeal joint stretches excessively, and the middle and distal joints flex. Claw toes do not usually cause pain or complications, but they can be an aesthetic problem.
There are two types of claw toes:
- Flexible claw toe: where one or more toes can be stretched to correct the position but then return to their particular form.
- Rigid claw toe: when it is impossible to correct the position of the toe, making it impossible to stretch.
Causes
Congenital origin is one cause, but not the most common. In almost all cases, the formation of claw toes is linked to wearing improper footwear that restricts space for the toes, forcing them to curl. When this is repeated, the toes begin to stay in this position as the muscles and tendons lose their normal parameters, giving the toes a "claw" shape.
How to treat claw toes?
It is advisable to avoid wearing pointy shoes or shoes that offer little space for the toes to prevent worsening the deformity. In severe cases, surgery may be necessary to restore the original shape of the tissues forming the affected toe(s). If the problem is not particularly advanced, it can be treated with special insoles to correct the toe's position, but it is always important to wear shoes that provide the necessary space for the toes to rehabilitate.
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