Had surgery in November 2007, was back to running in 25 days. All is good in Hooville.

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Lar Dog

this post needs pictures!

this post needs pictures!

He said hammer toe, not camel toe...

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Forget speedwork. Speedwork is the icing on the cake and you don't have a cake yet. - MattinSF

Basically they have 9 tenants, live life to the fullest, do not turn the cheak, and embrace the 7 deadly since. - TheForge (on satanists)

Sure - easily fixable. Can be easy (in office percutaneous flexor tenotomy) to more difficult (PIPJ arthrodesis with MPJ release) to major (joint implant arthroplasty) for a runner.

Need a LOT more info ...

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

My bad :)

I have always been curious. I have hammer toes, no pain involved. So probably no too severe. I wonder if I did not have them, if I could run better. The toe off phase might be stronger? Am I just reaching here?

rroof...

I was hoping you saw this. And NO...I do not have pictures and to be clear (especially since I'm a dude) this is potential hammer toe, not camel toe. If you want to see what hammer or claw toes look like, google it. It's nasty. The "other" toe...well that is a different story.

I raced on Aug 10 at the Boulder 5430 and stepped on a huge rock beneath the surface of the water as I was running in for my heat. Prior to the race, I fought with an intermetatarsal neuroma for most of the year. I had the injections in Feb and that literally fixed everything until late April. I had a half marry that featured a long steep downhill and while I was flying down that thing (feet slapping) I noticed the pain return and it's been around since then. The pain or discomfort never reached the levels prior to the injections so I figured I would deal with it after the last race. During the summer, I noticed slight movement in the angles of my toes (2-4). There was a noticeable gab between the 3rd and 4th toe that wasn't there before. Also noticed the 2nd and 3rd toe were crunching into one another creating infrequent blisters in new spots. Little body glide fixed that. However, season was rounding into form and as the discomfort was ok...no problem.

So I step on this damn rock and the pain is intense, but it's the beginning of the race that I traveled across the US for and I didn't want to get swam over so I went on. Pain was a distraction the whole swim and really killed me when I hit the beach. I smoked the bike hoping it would get better, but knew it would not be possible to run. While in T2, I noticed my second toe was pointed up...I mean considerably up. I tried to run, but after 50 yards there was simply no way. Pain was insane. Med tent doc thought I had a chipped bone in my toe or maybe a broken metatarsal. He suggested I get X-rays pronto.

Couple days later (after MUCH ice, Tylenol and Aleve) I returned home to get X-rays. No broken bones, but the doc said I had severely bruised metatarsals and a punctured plantar sheath causing the 2nd toe to prject upward. She instructed me on how to tape it down (which I have done religiously for over a week) and provided me with a air-cast boot to wear.

Since then, the swelling has subsided. It's still very awkward to walk. The pain is ever present and I notice that the 2-3rd toes seem to have an arch in them that appears similar to the hammer toe pics I see on the net. The taping style she instructed me on was to prevent hammer toe, but I fear it hasn't done anything. Perhaps it's just too early yet. She thought I might need to wear the boot / tape the toe for 30 days. I'm typically a quick healer, but this time is just doesn't feel right to me. I know my toes and they don't look normal. I know hammer toe can be trauma induced, but my larger fear is that it pre-existed the injury. The toes seem to want to flex in the middle rather than staying flat if I attempt a normal easy toe-off.

Are there stretches I should be doing? Other O-T-C treatments?

Thoughts?

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ADW

Yes, you are "reaching"

Many people have "hammertoes", clawtoes, malletoes, contracted digits, etc. They don't need addressed unless you are like the description below where the biomechanical deformity is beginning to cause pathologies. So run happy and run fast!

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

You have a lot going on here.

Hammertoes themselves are usually benign and nothing to be concerned about in most people. However, they do predispose you to other pathologies that you are now experiencing. Lets assume you really did/do have a Morton's neuroma (often misdiagnosed). You probably had 2-3 steroid injections to calm this down (which it apparently did). However, lesser MPJ capsulitis, metatarsalgia, etc. would have also improved with the steroid injection. But, the bad news is that it can further weaken the plantar (volar) plate) and with a runner and continued repetitive trauma, this can cause the dreased "pre-dislocation syndrome" (a term coined by the late Dr. Gerard Yu) that you are now describing. Once the plantar plate is damaged/attenuated, the lesser MTP joint continues to sublux and eventually the digit almost completely dislocates dorsally and usually medially as well, causing some pretty significant and chronic pain and swelling in the area/ball of the foot. This is also a very difficult thing to fix (surgically I'm speaking) with limited long term success in runners especially. Taping the toe down and offloading the joint is a good idea for now, but most do not find this helpful over the long term.

Probably best to PM me if you need/want any more info. Just wanted this on the main board so that others may learn if needed.

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

This is pretty much what I experienced. It progressed to the point that eventually I had to have surgery to straighten the toe and make it shorter. It took about 8 weeks before I could be weight bearing again (what a pain that was) and about 3 months before I could get back on the bike and start running. It has been two years since the surgery and there is still some discomfort mostly from the scare tissue, but it has not stopped me from racing. From my experience, this type of injury can be pretty tricky to fix, so if you eventually need to go down the surgery path, make sure you get a good doctor who has had lots of experience with this sort of injury. I went through three doctors before I found one I felt I could trust with the surgery.

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mikew

jeeez....

These last two posts just took the wind out of me. I'm going to call the Doc and ak her to look at it agin next week.

rroof, I'll PM you after the and let you know what she says.

Thanks!

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ADW

Rodney,

Went back to the Dr today. She injected the MTP joint with Cortizone and thinks there is a possible tear in the plantar plate. I have been very obedient in terms of icing the area, wearing the boot as much as I can and taping the second digit down. The second toe is still elevated and there is still a bit of an arch in it, but not what I would call a full-on hammer toe. She suggested it takes 8-12 weeks for a ligament tear to heal and we are only 3 weeks in. Since there is still swelling around the bones and pain / stiffness in the toe she did the injection. I have a follow up in 3 weeks. If there is no progress at that point, she thinks the surgery to repair the plantar plate is the right move.

I have to admit, I thought I would see more progress at this point. I feel the doc is competent, but the prospects of surgery are less than exciting. We'll see in 3 weeks.

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ADW

Be careful what you wish for....

sounds about right as far as treatment and prognosis. Unfortunately, my experience with plantar plate tears is not so positive in that they rarely heal up well long term (esp for a runner). You have had an MRI/ultrasound? Amazing how debilitating a simple 2nd MTP joint can be, huh?

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

You are definately reaching. my sister has hammer toes and has set an age group record (Canadian) for the marathon!

X-ray only at this point. I'm sure befor they do any cutting we'll do MRI or ultrasound. If they don't suggest it in 3 weeks, I should push them for it...right?

And yes, very frustrating. Been a runner since age 15 (23 years) and never had a significant injury. Some slight IT band stuff when I was at Ohio U...but otherwise, nothing serious. It sucks...

Even harder to watch other people running now...

I'm going to look like that gal in the picture if I'm sidelined very long...

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ADW

Oh my goodness.... I have had this and still have photos of the foot showing the significant swelling.

It's two years now and am running comfortably but not like I used to.

Thanks for the info !

I've got one & it doesn't bother me itself. But I've noticed a tenacity to develop blisters on that toe. I think because its riding higher in the shoe & the nail is pushed back. (My shoes do fit well with room in the toe box so that's not it.). I did the Portland Marathon on Sunday & got a really bad blister one the toe & kinda under the nail I guess. Painful swollen. Been using epson salt soakes.
Anyway its gotten me to thinking I need to look at what I can do "biomechanically I can do to help stretch/strengthen the toes.

Barb