(1.) Pain caused by toenail issues, such as a fungal infection or prior injury to the toenail.
(2.) Hammertoe deformity -hammertoe deformity is where there is an abnormal contracture of the toes, causing an atypical position and alignment to the foot, which can cause abnormal stress or pressures that go through the toes and lastly
(3.) Swollen nerve referred to as a neuroma -this happens a little bit further proximal in the foot where the nerve can get impinged or swollen. This is a normal nerve that due to injury or overuse becomes swollen and painful. The pain can be a sharp or burning type that can go into the toes.
- Toenail problems-toenail fungus is a very common problem that we see. It has been reported that 20% of the general population and 75% of people over the age of 60 are affected with toenail fungus. Toenail fungus can cause the nail to become misshaped and thickened which can cause abnormal pressure going through the nail bed and the tip of the toe, which can result in again in a painful or sensitive toe. A toenail that has been damaged or injured can also result in an abnormally shaped or thickened nail. We call this a dystrophic nail. Toenail trauma to the nail bed and/or the cells that make the toenail, which are called the matrix, can forever produce an abnormally thickened or misshaped toenail. This abnormal toenail that is misshaped or thickened can again cause abnormal pressure going through the tip of the toe and pain.
- Hammertoes- hammertoes are when there is an abnormal contracture of the toes, causing a change in shape and position of the toe. There are many causes of hammer toes. One of the most common causes of a hammer toe is the result of having a flatfoot. Each foot is comprised of 26 bones. In a normal foot those bones are supposed to maintain a certain shape that adds stability and rigidity to the foot to ultimately provide a rigid lever to push off and move forward. A flatfoot is where those bones are loose and the arch falls. This tends to be an unstable foot; we call this a “loose bag of bones” or an apropulsive foot type. We tend to compensate by recruiting the toes to help provide stability. We overuse the function of the toe to help stabilize the foot and in the long run, cause contracture of the toes, and therefore a hammertoe.
- Neuromas- a neuroma is a swollen or thickened nerve in the forefoot that may end up resulting in a burning or stabbing pain. It can also cause a feeling of having a lump or a pebble on the bottom of the foot. You can experience tingling or numbness in the foot or into the toes. Neuromas can be caused by wearing a shoe with a tight toe box or simply overuse from sports, for example, tennis or rock climbing.
So how can a shoe help these three conditions?
If a shoe provides extra support, it will ultimately allow the toes to rest, making them work less than they normally would have. A supportive shoe tends to have a firm or rigid soul thereby limiting or slowing down the flexion of the shoe in the forefoot. This again will reduce pressure going through the toes and reduce force going through the toes, which may ultimately reduce pain into the toes.The size of the toe box is also very important to try to help reduce pain in the toes. If your pain is caused by abnormally thick toenails, then less pressure going through the toenail should help reduce the sensitivity of the toe. The most common plane of a hammertoe is in the sagittal plane which ends up resulting in the toe being in a higher position than normal. The top of the joint can be easily irritated by a shoe that has a normal depth. Having a shoe with a larger and deeper toe box will help reduce that pressure going through the top of the knuckle and thereby reduce the pain going through the toe. A neuroma is a swelling of the nerve at the base of the toes in the forefoot so any lateral compression from the shoe may cause increased symptoms and pain. Having extra room in the toe box and extra width will help reduce that side-to-side compression and ultimately help reduce the pain.
Adjustability of the shoe is also very important in reducing to pain. Having a shoe with laces or Velcro is much better than a shoe with a finite capacity in the toe box. The laces or Velcro again will provide the opportunity to adjust the shape of the toe box to help reduce pain in the toes or toenails. And finally, shoes that have removable insoles are very beneficial to help minimize pain. If we can remove the existing insole this will give us the opportunity to make modifications underneath the foot. We can simply cut out apertures to offload certain tender areas, we can add padding to certain areas of the insole to change pressures and then finally, we can upgrade the existing insole to an arch support or even a custom-made prescription orthotic.
If you are having toe pain, see your local podiatrist for an accurate diagnosis however, these are some simple suggestions that may help reduce or even solve your problem.
Written by
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com
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