Q My middle toe on my left foot curls downwards and under my second largest toe so that when I run, the bigger toe pushes down onto it. This is rather painful. A physiotherapist told me that the problem could be caused by my flat arches, but the orthoses they prescribed dont seem to help. Will I need surgery to straighten my toe if Im to run without pain?A The chances of your needing surgery to straighten the toe are very low indeed. Most of these problems can be solved non-surgically by a podiatrist.
It could well be that the arches of your feet are causing your toes to curl and therefore need treating, but there are two aspects of the treatment which appear to be missing.
1. Silicone splints to straighten the toes. These are putty-like inserts carefully designed to straighten the toes. They sit underneath the toes, and you simply put your socks on to keep them in place. Silicone splints need to be fitted by a state-registered podiatrist. Contact the Society of Chiropodists and Podiatrists to find one in your area.
2. Intrinsic muscle exercises need to be used to improve the strength of the small muscles that hold the toes in their correct position. These can be demonstrated to you by a podiatrist, but generally involve pressing the toes down hard against the ground, keeping the heels on the floor, and lifting the ball of the foot (the metatarsal heads) upwards, ensuring that the toes do not start curling as you do the exercises. These toe press-ups need to be repeated 300-400 times a day until you can perform them efficiently. You may have to hold the toes in place by hand until the muscles learn how to move the toes correctly.
With or without orthoses in your shoes, use the silicone splints and the intrinsic exercises for the toes, and you will find that the toes gradually straighten, which should avert the need for surgical intervention.Simon Costain, podiatric consultant