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I received a question on Twitter that I’ve heard before:

Question: “Once the 2nd toe has ‘crossed over,’ can the stretches help to avoid surgery? Would love to walk barefoot again without pain.”

The short answer is yes, but it depends on the source of the pain. The skinny is that the hammer toe and the pain may not be the same thing.

Second MTP synovitis pain is experienced in the ball of the foot. Hammer toe pain is felt on the knuckle (top of PIP joint) sticking up and hitting the top of the shoe. These are clear and different pains. And it does not require an ultrasound or MRI to tell the difference. Just a few questions and a bit of simple exam will do. The problem is we look at the foot, SEE the hammer toe sticking up and maybe crossing over and at the same time feel pain, thus they are the same problem.

True, true, maybe unrelated.

Then we see a doc and the offer to fix the “obvious” problem, the hammer toe, is made. Don’t get me wrong, hammer toes need to be fixed often, but only when they are THE PROBLEM.

The problems with this logic, actually lack of logic, are many. The hammer toe often needs no surgery, unless it is the actual source of pain at top of the knuckle. The underlying true problem is all the while missed and never addressed. I have seen my share of patients come in with a surgically corrected straight toe still in pain only because the pain was not addressed by the deformity correction. Accurate shot, wrong target!

Here is the kicker, the original inciting problem, the isolated gastrocnemius contracture can be fixed without surgery thus fixing the actual pain, the second MTP synovitis. Sometimes one must think outside the box.

I think you get it.

Stay healthy my friends,