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Help for Hammer Toes



Bottom Line/HEALTH: Some of the sexiest women in the world have some of the least sexy feet you’ve ever seen. Katie Holmes, Penelope Cruz, Angela Bassett, to name just a few. And yet these women are still wearing strappy sandals. The question is, should they be? This is the Bottom Line on hammertoes.

I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversations With the Experts, where we get the answers to your tough questions from our leading experts.

Today I’m talking to Dr. Johanna Youner, one of the leading podiatrists and foot surgeons in New York City. Welcome, Dr. Youner.

Dr. Johanna Youner: Thank you, Sarah. It’s great to be here.
Bottom Line: These sexy, sexy women—gorgeous—and yet when you look at pictures of their feet, scary stuff. So let’s look at what a hammertoe is…see what’s going on and then learn how to stop it. First of all, what is a hammertoe?
Dr. Youner: A hammertoe is a contracted lesser digit, meaning not the great toe. It is the second, third, fourth or fifth toe, and it starts to contract, like a little shrimp, over time. It can be from walking, genetics, many factors. But if you look down and your toe starts to look contracted like a shrimp, with a little bump on it, chances are you have a hammertoe.
Bottom Line: You said it can be from many causes. Let’s go through those. Genetics, somebody’s genetically predisposed to them?
Dr. Youner: If you’re genetically predisposed, you’ll probably get them because it’s the way you’re walking. As we walk, our feet tend to grab, and over time, the grabbing will stay. So your feet will start to stay in the position of grabbing. That would be genetic. If you wear high heels that force the feet into the end of the shoes, the toes will be crunched into a hammertoe position. Over time, pressure on the bone will make the bone grow, creating a hammertoe.
Bottom Line: Given the variety of shapes and sizes of feet, how do you know if you’re getting a hammertoe?
Dr. Youner: If your toe does look like it’s curling up, chances are you have or are getting a hammertoe. It’s very, very common, and it’s almost a normal variant. If the toe is starting to be painful in shoe gear, then it’s something to be looked at.
Bottom Line: One thing that shocks me—we think of bunions as an old person’s issue. But hammertoes—these women, these celebrities, are very, very young. And yet their feet are quite curled up.
Dr. Youner: The hammertoe develops much more quickly from a fashionable shoe. So if you have a celebrity wearing a four- to six-inch heel, the foot is being forced into the shoe, and the toes are being bent down. It is literally creating a deformity inside the shoe.
Bottom Line: So let’s look at a couple, and let’s see if they’re mild, moderate or “Oh my God, get to the doctor fast.” First we have Charlize Theron. Doesn’t look so bad. It almost looks like a normal foot.
Dr. Youner: Those look pretty mild. Her second toe is slightly contracted, as is her third toe. But she doesn’t have large pink bumps on them. That would indicate to me that this is a longer-term problem. It may simply be that the shoe also is so high, her feet cannot even stay inside the shoe without contracting to hold them in.
Bottom Line: So this is the start of it. Next we have Penelope Cruz.
Dr. Youner: Ah, Penelope Cruz seems to have some issues. On her second, third and fourth toes on the right foot, she has mild to moderate hammertoes.
Bottom Line: All right, and then last but not least, the lovely and beautiful Katie Holmes. And young. Again, young.
Dr. Youner: Katie Holmes’ toes—she does have hammertoes on the two, three and four on both feet, and the toes look like they’re holding into a high-heeled shoe. The shoe is so unstable, that the foot is trying to stabilize itself. And this can develop a hammertoe by simply the foot holding.
Bottom Line: Each of these women, mild to more severe, should they be going to get treated?
Dr. Youner: I would think Katie Holmes needs orthotics. Simply by looking at this photo, I can see on the right foot that she has a bunion. It’s a pretty severe bunion. This bunion needs to be straightened out by simply using an arch support. Using an arch support will straighten the bunion out, and the lesser toes will then begin to straighten. The bunion will push the toes into an abnormal position.
Bottom Line: Do bunions and hammertoes usually come together?
Dr. Youner: Absolutely. A bunion will create a hammertoe.
Bottom Line: Will a hammertoe create a bunion?
Dr. Youner: Not necessarily.
Bottom Line: The thing that’s shocking to me, though, is that so many of these women have got all the resources in the world, they’ve got all the money in the world—and yet they seem not to be getting treated. Is the treatment bad?
Dr. Youner: The treatment to straighten the hammertoe will involve breaking and resetting the toes. And if you’re going to wear pretty shoes again, you’re going to create the problem again. So if you’re going to remain a celebrity, then chances are you don’t want that fixed so quickly. Especially the hammertoes. The bunions, if they become painful, need to be fixed, but not the hammertoes.
Bottom Line: So aside from deformed feet, is there any risk to leaving them untreated?
Dr. Youner: If you keep deforming your feet, you will end up with arthritis and you will end up with pain. So there has to be common sense. If this is the way you’re living, you need to understand that there has to be an end in sight. You cannot do this for the rest of your life and expect not to need surgery.
Bottom Line: Let’s talk about treatment options. Surgery—I’m hoping surgery is down at the last option.
Dr. Youner: To start, looking at some of those toes, I think exercises can stretch them. So if we take a look—say you’ve noticed that your toes curling up like little shrimp. You can just gently bend the toes, all the toes, including the big toe, gently up a couple of times. You can do this four or five times to up to 10 times at a night, just to stretch the ligaments on the bottom of the foot. You want to stretch them out so they’re not contracted. You want to stretch them back to where it was before you started wearing shoes like that.
Bottom Line: And I understand that there’s some kind of a brace or something?
Dr. Youner: YogaToes is an excellent adjunct to stretching the toes. You literally put the YogaToe between the toes, and it stretches the toes, separating them. The ligaments are pliable. Those are the long, pulley-like structures on the bottom and on the top. If you stretch them back, it will release some of a hammertoe that’s not completely bony. If it’s a soft tissue hammertoe, it will help.
Bottom Line: What are the prevention options?
Dr. Youner: Shoes that fit.
Bottom Line: Oh, that.
Dr. Youner: If you put your foot down next to your shoe—if they don’t look similar—don’t wear them. If you stop wearing fashionable shoes for a year, chances are your little red lumpy bumpies will disappear.
Bottom Line: All right, I’m going to tease you a little bit. You’re wearing very pointy shoes. And we talked earlier…sometimes, you’ve just got to wear those pointy shoes. So what’s the strategy?
Dr. Youner: There are ways to get away with pointy shoes. One is to wear a larger size with a longer point. If I wear a half size longer, my toes are all the way back here. They’re not being squashed. I can tell this by an X-ray. I can take an X-ray of my foot and see, my toes are actually straight.

So if you must wear a fashionable shoe, wear one that’s a half size larger, with enough room in the point for your toes. And wear an arch support that straightens out the foot inside the shoe.

Bottom Line: If somebody exercises their feet even before they get hammertoes but they know that they’re wearing the inappropriate shoes, can that help prevent hammer toes?
Dr. Youner: Yes, it can, because it’s stretching out the tendons that create the hammertoes.
Bottom Line: All right. Thank you, Dr. Youner. The bottom line on hammertoes? Wear shoes that fit…stretch your feet morning and night. This is Sarah Hiner with Bottom Line Publications.
Source: Johanna S. Youner, DPM, a podiatric surgeon in private practice and attending physician at New York Downtown Hospital, both in New York City. Dr. Youner is a board-certified foot surgeon and a Fellow of the American College of Foot and Ankle Surgeons. Date: October 1, 2014 Publication: Bottom Line Health
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