Fingers and toes represent the masterful engineering of mother nature found in human and primate anatomy. For simplicity, toes are the focus today, but their design is alike.
Toes are comprised of three phallanges (sing. phallanx), or toe bones, except for the big toe (hallux) which has two. When the toe meets the foot, a "knuckle" is formed at the base. Therefore, the average toe has three knuckles, one at the base, one far away, and one in the middle.
Toes, like fingers, can flex, as when grabbing a pen, or extend, as when releasing the pen. Specific muscles are responsible for these actions.
Claw toes occur when the two distal toe knuckles are stuck in flexion and the base is stuck in extension. When looking at claw toes, they appear "scrunched up," the toe tips are visibly held close to the ball of the foot, while the proximal knuckle is acutely extended such that the middle phallange (toe bone) looks like it would rub against the roof of a shoe while walking.
When the middle knuckle is stuck flexed, and the other two are stuck in extension, it is called hammer toes. The middle knuckle rides high all by itself.
Mallet toes, while rare, occur when the distal knuckle is frozen in flexion.
Each abnormality results from an imbalance between the flexors and extensors. When a muscle is weak (inhibited), it's partner antagonist becomes relatively tight. Then place the foot in a cramped shoe for over 6,000 steps per day, year after year, and voila: the toe gets stuck in its predisposed deformity. Then the deformity rubs within the shoe leading to complications like corns and blisters. What is it that decides whether the resultant deformity is a claw or a hammer?
It is critical to understand anatomy when answering that question. Each muscle set has a unique anatomy from different nerves, different spinal levels, and following unique routes to their destination.
Claw toes result when the long extensor muscles of the distal two toe bones are inhibited (weak). Many things can cause this, all of which interfere with the brain-muscle connection or the anatomy of the muscle. A short list would include any lower lumbar vertebral misalignment, sacroiliac joint problems, posterior fibular head, ankle strain/sprain, or tarsal tunnel.
The differential diagnosis for hammer toes would be the same, but the priority of where to look first as a clinician would be altered because different muscles are involved.
The best option is to consult a chiropractic applied kinesiologist. These individuals are skilled in assessing the muscles and correcting deficiencies at low cost. The treatment plan may include spinal and extremity adjustment, dietary/nutritional counseling, acupuncture/acupressure, gait correction, and shoe evaluation, perhaps with orthotics. Orthotics are given after all other corrections have met maximum medical improvement. Look for an applied kinesiologist near you by visiting the International College of Applied Kinesiology (ICAK) online.
Toes are comprised of three phallanges (sing. phallanx), or toe bones, except for the big toe (hallux) which has two. When the toe meets the foot, a "knuckle" is formed at the base. Therefore, the average toe has three knuckles, one at the base, one far away, and one in the middle.
Toes, like fingers, can flex, as when grabbing a pen, or extend, as when releasing the pen. Specific muscles are responsible for these actions.
Claw toes occur when the two distal toe knuckles are stuck in flexion and the base is stuck in extension. When looking at claw toes, they appear "scrunched up," the toe tips are visibly held close to the ball of the foot, while the proximal knuckle is acutely extended such that the middle phallange (toe bone) looks like it would rub against the roof of a shoe while walking.
When the middle knuckle is stuck flexed, and the other two are stuck in extension, it is called hammer toes. The middle knuckle rides high all by itself.
Mallet toes, while rare, occur when the distal knuckle is frozen in flexion.
Each abnormality results from an imbalance between the flexors and extensors. When a muscle is weak (inhibited), it's partner antagonist becomes relatively tight. Then place the foot in a cramped shoe for over 6,000 steps per day, year after year, and voila: the toe gets stuck in its predisposed deformity. Then the deformity rubs within the shoe leading to complications like corns and blisters. What is it that decides whether the resultant deformity is a claw or a hammer?
It is critical to understand anatomy when answering that question. Each muscle set has a unique anatomy from different nerves, different spinal levels, and following unique routes to their destination.
Claw toes result when the long extensor muscles of the distal two toe bones are inhibited (weak). Many things can cause this, all of which interfere with the brain-muscle connection or the anatomy of the muscle. A short list would include any lower lumbar vertebral misalignment, sacroiliac joint problems, posterior fibular head, ankle strain/sprain, or tarsal tunnel.
The differential diagnosis for hammer toes would be the same, but the priority of where to look first as a clinician would be altered because different muscles are involved.
The best option is to consult a chiropractic applied kinesiologist. These individuals are skilled in assessing the muscles and correcting deficiencies at low cost. The treatment plan may include spinal and extremity adjustment, dietary/nutritional counseling, acupuncture/acupressure, gait correction, and shoe evaluation, perhaps with orthotics. Orthotics are given after all other corrections have met maximum medical improvement. Look for an applied kinesiologist near you by visiting the International College of Applied Kinesiology (ICAK) online.
About the Author:
Charles Leahy writes about alternative healthcare. Find a great glen ellyn chiropractor, and learn all about applied kinesiology.
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