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Hi All.

I'm a student who is confused about suggesting treatments to patients with hammer toes. I was wondering if someone could please help. I was wondering whether it would be appropriate to suggest toe stretches to patients as I know all our treatments are meant to be evidence based. However, the problem is apart from some Podiatry clinic sites suggesting the stretches, I can't find any research to their effectiveness, though I can't see that toe stretches would do much harm in a healthy patient. Any advice would be much appreciated. Thank you

 

If I was your teacher I would 1st ask what causes Hammer toe deformity ?

and what are you going to stretch ?

I would also suggest that if fact you may want something to be have greater tension as a hint.

 

Thanks Mike.

Very good advice, Most appreciated

 

You have the research question for your long term study.

As you look at infants and young children you very rarely see hamertoe contractures. I would say that the incidence increases with age. As you examine feet without hamertoes they have range of motion up and down at the MPJ. At the pipj the toe is able to get straight. With hammertoes, you don't see that same range of motion. It appears developmental in that there is a change in the joint capsule or some other structure over time that alters the range of motion seen in those joints. It makes logical sense that if someone routinely stretched their joints the contractures may not develop.

After manipulating a club foot in an infant it's quite amazing to see the change in position over weeks. I haven't seen any research on this, but it might be interesting to do. Can a stretching protocol alter available range of motion of the MPJ and pipj over time? An even longer term study with many more subjects would be can a stretching program prevent the development of hammertoes over the years. There are a lot of developmental questions to be answered that we should give to young students so that they can plan their careers around answering thes questions that need a lot of time to answer.

Eric

 

Hi Eric:
Case in point. I recently did achilles tendon lengthenings on a 13 year old female with pes cavus, contracted MTPJ 1-5.
After several weeks all her MTPJs were significantly more rectus and less contracted, even the IPJs although the only procedures done were the TALs..

This is not unusual but I think clearly demonstrates the effects of a tight gastro-soleus on the forefoot.

Steve

 

So do you think aggressive calf stretching for ppl with more flexible and intact ROMs hammer toes could prevent the need for surgery?

 

Hi Dragon:

I do. I prescribe achilles and extensor stretches frequently. I try to impress upon the patient the importance of doing these and that they may keep them out of the operating room - some follow through and some don't.

There are patients, like this young girl, with true talipes equinus that no amount of stretching is going to correct.

Steve