Heel Pain from...Stilettos?

While us commoners might not have heel pain from Mr. Choo, Vuitton or Blahnik, we still wear our beloved 4-inch stilettos (maybe their Steve Maddens or Sam Edelmans…) When our heels, however, constrict our foot, we are bound to have increased foot pain ranging from hammertoes or “simply” bunions, corns or calluses. That’s not going to keep us from wearing those shoes on our weekend nights or working girl days, so what precautions can we take to prevent that want of taking them off 15 minutes after we put them on?

• Make sure the shoe fits- yes, you might encounter a deal that’s too good to pass up at T.J. Maxx but if you only wind up wearing them for half the night because they’re too tight, they will only take up valuable closet space!
• Where does it hurt? – If your entire foot endures pain, get a shoe length cushion insole, or if its just the balls of your feet, purchase silicone metatarsal pads
• Thicker heels- we’re in luck ladies, the thick heel is on it’s way back! This helps relieve some pressure from the foot rather than the pin needle heels
• Gradual slope- do most of your heels look like you’re going to fall face-forward when you stand in them? Try looking for cute heels that have a gradual slope instead to alleviate some pressure on the ball of the foot
• Open-toe heels- this style might not always be possible, but again panty hose with open toe heels is back (dark tights + dark heels). Open-toe heels help reduce corns and calluses which should be removed by a podiatrist

Hammertoes

Digital contraction deformities include hammertoes, clawtoes, and mallet toes.



There are three main causes of digital contracture deformity:

Flexor Stabilization- occurs about >70%. The muscles in the back of the foot and leg fire earlier and longer to stabilize the hypermobile fore foot. This results in overpowering the little muscles in the foot causing the hammertoe. It is possible to see rotation of the 4th and 5th digits with this type of deformity.

Extensor Substitution – is associated with a high arch foot, foot drop, and a weakness of the muscles in the front of the leg.

Flexor Substitution – is the least common cause of digital contracture, and occurs due to weakness of the muscles in the back of the leg.

A mallet toe involves bending of the far toe joint downward and may be associated with a long digit.

Hammertoes involve upward bending of the the first bone in the digit and downward bending of the middle bone in the digit.

The clawtoe involves downward bending of both the middle bone and the far bone of the digit.

Symptoms associated with advanced digital contracture deformity include painful motion, painful hyperkeratotic lesion (Thickened Skin), inability to wear regular shoes, contracted painful toe which is short.

Treatment for claw toes and hammertoes depends on the severity of the deformity.

Goals are to keep the foot comfortable:

If biomechanics is the reason for the hammertoe deformity tan the patient can be fitted for custom-molded orthotics.

Changing to a wider pair of shoes, with more depth in the toe box.

Hammertoe pads or Hammertoe cushions can also be used on hammertoes.

Padding placed under the toes, with a strap that is placed over the toes which helps to straighten the toes.

Pads and cushions can help to alleviate pain and irritation of the toes, these pads however will not change the deformity.

It is possible that the soft tissue structures can begin to tighten. A rigid deformity can develop in such a case.


When conservative care fails and there is considerable pain at the hammertoes, surgery is then considered.

Hammertoe surgery involves straightening the toe through either an arthroplasty by removing a small piece of bone of the digit, or arthrodesis (fusing the joint) using a wire or implant.

Arthroplasty is a minor surgical procedure that may be used to treat hammertoes. In this procedure, the head of the first bone in the digit is removed, allowing the toe to straighten. If the affected toe does not straighten sufficiently after arthroplasty, a number of progressive stepwise soft tissue procedures can be used to attempt to straighten the toe.

In some cases an arthrodesis is necessary. Arthrodesis involves fusing two bones together, typically the first and second bones of the digit. The articular cartilage is removed from each bone. They are then held together with either a pin or an implant.

Following surgery, the patient is placed in a surgical shoe or boot and the patients has limited activity for several weeks.