This week we continue our discussion on orthotics, and will cover how orthotics may or may not be of benefit for hammertoes and neuromas, two very common conditions afflicting the feet.
Hammertoes, for the most part, are toe contracture deformities due to imbalance in the function of the muscles that pull the toes up versus the ones that pull them down. This imbalance is due to one's foot structure, as both flat feet and high arches create enough instability in the way the foot functions that the muscular balance is disrupted. Eventually, hammertoes develop. Some rare cases of hammertoes are due to neuromuscular disease, although this is very infrequent in the general population, and outside of this discussion today.
Orthotics have a limited role in helping this hammertoes, and only in the case of flat feet. Hammertoes that have already developed will not be reduced by orthotics, no matter what some salesperson tells you. Here in Indianapolis we have heard of retail stores informing our patients that shoe inserts can 'cure' hammertoes, and this is just nonesense. In essence, orthotics can only help by reducing the flattening of the foot, and in the course of many years use will simply decrease the imbalance that leads to progressive worsening of the deformity. If used from a young age, the orthotics can conceivably limit the development of the hammertoe deformity, although some deformity may still follow. If the use of orthotics is delayed into adulthood, their use can still slow down the progressive worsening of the toe contraction over many years, and may prevent once painless hammertoes from becoming more painful. However, once again, orthotics will not change or alter toe deformities that have already taken place. Only surgery can do that. In the case of high arches causing hammertoes, the use of orthotics will not likely be of any use. High arches cannot be controlled with orthotics in the same sense that a flat foot can, and so the cause of hammertoes in high arched feet cannot be lessened. Only surgery or deep shoes and padding can be used in these cases.
Neuromas are a nerve inflammation condition that can be directly affected by the use of orthotics. When there is excessive pressure to the ball of the foot, either through splaying of the foot when it flattens, or excessive shock when a high arched foot slams on the ground, the nerve tissue that runs in between and under the long bones of the foot becomes injured. This injury results in a focused area of thickening of the tissue that surrounds the nerve, and can lead to pain in the ball of the foot, along with numbness, burning, and/or tingling of one or two toes.
Orthotics play a part in the treatment of neuromas by reducing the damage to the nerve tissue as they control the underlying structural problem causing the damage in the first place. By reducing and redistributing pressure at the ball of the foot, orthotics work well in both flat feet, as well as higher arched feet. In this condition, unlike in hammertoes, orthotics are useful with higher arches in that they reduce direct pressure to the ball of the foot and help to absorb the shock of walking, something a high arched foot has difficulty doing on its own. When combined with anti-inflammatory treatment, orthotic use with neuromas can essential cure the nerve tissue damage, and help prevent its return, at least in a significant number of cases.
Next week we will finish this topic by discussing two more conditions orthotics can help with.