Extension at the MPJ; flexion at the PIJ
Hammertoe deformity (sometimes written as hammer toe) is a condition of one or more of the lesser toes, characterized by extension of the metatarsophalangeal joints (MTPJ) and flexion of the proximal interphalangeal joints (PIJ). To find your MTP joints, lift your toes off the ground – it is that junction at the base of the toes. Lifting them off the floor puts them into extension. PIJ is the next joint along the toe, which in hammertoe deformity is often flexed or in the position of making a fist with your toes. Sometimes the distal or last toe joints are also extended, which I could demonstrate by lifting the tip of the toe of my foot anatomical model.
Not only can hammertoes be painful, many who have them are self-conscious wearing sandals or going barefoot because of how their toes look. If you have hammertoes or suspect that you developing them, here are some things you can do.
Evaluate and update your footwear
It is widely accepted that hammertoes are made worse by narrow shoes and high heels. I use italics because most of my clients don’t consider their narrow or high. Here is a simple test for narrow. Remove the insert from your shoe, stand on it, and spread your toes. If your toes spill over the sides, your shoe is too narrow. Period. The great majority of shoes have positive heels, which means the heel is at a higher elevation than the toe of the shoe. Technically, this is a high heel that changes your geometry and therefore your gait – thus where/how your land on your feet, when standing, walking, or running. Look for shoes that are zero drop, meaning there is no drop in elevation of the shoe from heel to toe.
Another ubiquitous shoe feature to avoid is toe spring – that perky lift at the toe area of a shoe. Toe spring is a feature meant to facilitate toe extension phase of walking/running. It is a necessary evil in most shoes because their stiffness undermines our natural ability to extend our toes in gait. The problem is that toe spring keeps your toes in constant extension, which is unnatural. You can see how constant extension would be unwanted in a condition like hammertoe deformity, where your toes are already prone to chronic contraction in extension. In the image below, you can see significant toe spring in the Altra on the right (a shoe that otherwise has good features like a wide toe box and zero drop heel) compared to the shoe on the left from OESH – a woman owned company that makes anatomically- and biomechanically-informed shoes for women. Not only is there no toe spring, they also have zero drop heels and toe boxes wider than your typical shoe – all features to seek in a hammertoe-defying shoe.
Toes spring in the shoe on the right
Shoes like flip flops, some sandals, clogs, slides, mules – any shoe that has a loosely attached upper and requires flexion through the first or proximal interphalangeal joint in order to keep them on your feet mimics and may reinforces problematic biomechanics of hammertoe deformity. Try walking in a pair clogs without scrunching your toes and you may find that you’ve kicked your shoe halfway across the room. If you are already experiencing hammertoes, you might consider decreasing the amount of time you spend in these types of shoes.
Train your toe flexing muscles
Some studies have shown a strength imbalance between toe extensors and toe flexors with extensors being stronger, pulling the MP joint into extension. It is thought that toe flexion at the first toe joint is in response to this imbalance. Natural Sports Podiatrist Dr. Ray McClanahan has a good video on this, where he shows passive stretching exercises. In addition to passive stretching, I suggest that you also add the following resistance stretching exercises as part of your everyday training.
Since it is thought that the MP joint is overly strong in extension, training greater strength in toe flexion is desired. From a seated position, cup your hand over your toes, curling your fingers over the tips of your toes to rest on the bottom side of your toes. Hold your toes firmly in place while attempting to curl your toes into a fist.
- Variation 1 – completely resist flexion of your toes for up to 7 breaths.
- Variation 2 – allow your toes to flex but against firm resistance – repeat up to 10 times.
Drop your toes
Katy Bowman of Nutritious Movement, one of my teachers, is famous for saying “drop your ribs” to get her clients to pay attention to when they are thrusting their ribs forward thus shearing their vertebrae, chronically extending their spinal muscles, and undermining intra-abdominal pressure. I see a similar phenomenon in my clients with hammertoe deformity, where they are chronically lifting their toes. I usually see it in balancing exercises, ankle exercises, and in the wear and tear on the tops of their shoes.
I pay attention to this and remind my clients, ad nauseam, to “drop your toes.” Eventually, they start noticing how they habitually contract their toe extensors and, problematically, how they use toe extension muscles more dominantly than the more appropriate muscle on the shin (tibialis anterior) when dorsiflexing an ankle. I work with them to learn to relax their toes and the top of the foot with some specific ball and sensing exercises and to control toe extension in ankle ranges of motion.
Stretch your calves
Research shows that study participants with hammertoes also have less ankle dorsiflexion – the position of your ankle, when walking up a steep hill. In some cases, this could be due to soft tissue limitations in the calves. Thus daily calf stretching and strengthening may be beneficial. From the calf stretch pictured below, I like to slowly rise up onto the ball of my foot to full plantar flexion (standing in tippy toes) and very slowly lower down to eccentrically load my calf, meaning it gets stronger while it is stretching.
Calf stretch
If your hammertoes reside in the Yakima Valley of Washington, you can find me at the clinic of Dr. Kara Lolley, where I help you move, move more, and move more of you.
Namaste, Michele
that I cut down to one 18″ length and three 6″ lengths that I use for various purposes as yoga props.
