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Dr. Brian Abelson

Hammer Toes: Finding Comfort and Relief


Hammer Toes

Hammer toes are a common yet often overlooked foot issue that can significantly disrupt the natural biomechanics of your feet. This condition causes a noticeable bend in the toes at the proximal interphalangeal joints, leading to discomfort and difficulty with movement. In this article, we explore how manual therapy can be a proactive solution, helping to reduce pain and improve function so you can regain ease in every step.


Our Success Rate is Over 90%

Our manual therapy approach for treating hammer toes has a success rate of over 90% in decreasing pain and increasing function. While complete resolution may not always be possible, our primary goal is significantly improving these key aspects, enhancing patients' overall quality of life.


Article Index


 

Introduction

Hammer toes may seem minor initially, but they’re a complex musculoskeletal issue rooted in the delicate balance of forces between the toe muscles. This condition is characterized by a flexion contracture at the proximal interphalangeal joint, causing the middle part of the affected toe to rise. If the distal joint flexes, it can lead to a claw-toe deformity.


Person Palpating Their Feet

The primary cause of hammer toes is often an imbalance between the flexor and extensor muscle groups responsible for maintaining proper toe alignment. The flexor muscles, including the flexor digitorum longus and brevis, pull the toes downward, while the extensor muscles, like the extensor digitorum longus and brevis, lift them.

The intrinsic foot muscles, particularly the lumbricals and interossei, are crucial in maintaining this balance.


The equilibrium is disrupted when the flexors overpower the extensors, leading to the characteristic ‘hammer’ or ‘claw’ deformity. Poorly fitting footwear, such as narrow, tight shoes or high heels, often contributes to this imbalance by forcing the toes into a flexed position. Over time, this shortens and tightens the flexor muscles and tendons, encouraging hammer toe formation.


Additionally, foot arch type plays a role. High arches (pes cavus) put excessive pressure on the ball of the foot, causing instability and potential toe deformity. In contrast, flat feet (pes planus) can alter foot biomechanics, leading to muscle imbalances.

Understanding the physiological and biomechanical aspects of hammer toes is key to developing effective treatment strategies, which will allow for a more personalized approach to managing the condition.



 


Hammer Toes Exercise Image

Exercise for Hammer Toes


Below is a detailed protocol of specialized exercises and manual treatments to relieve hammer toes. These exercises target the key anatomical structures involved, while manual therapy restores balance in foot biomechanics.


Specific Exercises


  • Pulling Toes Back: Stretch your toes back before getting out of bed. This exercise increases the range of motion and stretches the plantar fascia and intrinsic foot muscles, often stiff and contracted in hammer toe conditions.

  • Flexion and Extension: After stretching your toes, exercise flexion and extension to warm up the intrinsic foot muscles and extensor tendons. This will improve joint mobility and relieve the rigidity associated with hammer toes.

  • Toe Stretch Sit Backs: This exercise stretches the flexor tendons and plantar fascia, lengthening the contracted muscles and fascia and reducing the clawing effect in hammer toes.

  • Standing Toe Stretches and Calf Raises: Standing toe stretches improve foot and calf muscle flexibility, which is crucial for maintaining proper foot biomechanics and preventing hammer toes. Calf raises strengthen the gastrocnemius and soleus muscles, balancing the forces exerted on the foot and toes.

  • Towel Scrunches: Towel scrunches strengthen the flexor muscles and intrinsic muscles of the foot, specifically targeting the flexor digitorum longus and brevis muscles involved in toe-curling movements. Strengthening these muscles can alleviate the contracted state associated with hammer toes.



 


Manual Therapy For Hammer Toes Image

Manual Therapy for Hammer Toes


Manual therapy for hammer toes focuses on mobilization techniques that target the foot and lower leg to reduce tension, increase mobility, and correct biomechanical imbalances that contribute to hammer toes.


Traction and Torsion: This technique improves toe joint mobility, easing the stiffness commonly associated with hammer toes.


Interdigital Massage: This massage targets the spaces between the toes, releases tension in the interosseous muscles, and promotes better toe alignment.


Plantar Fascia and Flexor Muscle Mobilization: Focusing on the underside of the foot, this technique reduces tension and enhances flexibility in the plantar fascia and flexor muscles.


Gastrocnemius and Soleus Muscle Manipulation: This technique indirectly improves foot biomechanics and helps prevent hammer toes by addressing these calf muscles, which connect to the plantar fascia via the Achilles tendon.



 

Exercise and Treatment Demonstration


Hammer toes can be a painful and debilitating condition, making walking uncomfortable and difficult. This condition is marked by an abnormal bend in the middle joint of the toes, often leading to corns, calluses, and other foot issues. The primary cause is frequently linked to wearing shoes that are too tight, narrow, or pointed, which forces the toes into an unnatural position.



Facial Expansion: MSR Foot Pain Protocol

Treating hammer toes with fascial expansions provides a holistic approach that blends modern understanding of fascia, kinetic chain relationships, and principles from acupuncture and traditional Chinese medicine. This method connects fascial lines with specific acupuncture points like ST44, LV3, LV2, K3, and B60, forming a cohesive treatment plan. By addressing the altered biomechanics and inflammation linked to hammer toes, this strategy helps reduce pain, improve tissue mobility, and manage scar tissue. It also focuses on restoring proper alignment and function of the toes and feet, relieving discomfort, and preventing further complications associated with hammer toes.



 

Treatment Frequency Recommendations


Manual hammer-toe therapy often brings initial pain relief and flexibility within the first few sessions. However, realigning the toe and achieving long-term functional changes require consistent treatment, exercises, and possibly orthotics. The timeline for results varies based on the severity of the condition and patient adherence to the treatment plan.


Initial Treatment Phase:


  • MSR Manual Therapy: Two sessions per week for 2-3 weeks, or substitute with one 30-minute session per week.

  • Home Exercises: Daily routines as prescribed.


Response Assessment:

  • Assess progress after 2-3 weeks. If pain decreases and mobility improves, reduce therapy to 1 session per week and continue daily exercises.


Persistent Symptoms:

  • If symptoms persist, maintain two sessions per week (or one 30-minute session), and reassess weekly.


Maintenance Phase:

  • Once consistent symptom relief and optimal function are achieved, transition to monthly sessions. Continue daily exercises to maintain progress.



Consistent Effort for Lasting Hammer Toe Relief

Achieving the maximum possible resolution of hammer toes through manual therapy and associated treatments, such as exercises and orthotic interventions, typically requires a long-term commitment. It can take 4 to 6 months of consistent treatment to see significant improvements in toe alignment and overall function. This timeline reflects the gradual nature of soft tissue remodelling and the time needed for muscles and tendons to adapt to new positions. Consistent therapy over several months ensures the best possible outcomes for reducing pain and improving function.​



 


Why Choose Our Approach for Hammer Toe Treatment


Our comprehensive approach to treating hammer toes achieves over a 90% success rate in reducing pain and improving toe function. Here’s why our method stands out:


  • Established Expertise: Developed by Dr. Brian Abelson, the MSR methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients. This ensures you receive the highest standard of care for your hammer toes.

  • Thorough Assessments: We perform detailed evaluations to identify all contributing factors, including muscle imbalances, joint misalignments, and soft tissue restrictions commonly contributing to hammer toes.

  • Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target areas of fascial tension and joint dysfunction, providing effective relief and promoting toe realignment.

  • Customized Exercise Programs: We create personalized exercise plans to enhance foot mobility, strengthen the muscles supporting your toes, and improve overall foot function, aiding recovery.

  • Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, exercises, and supportive measures, providing a comprehensive and lasting solution. We establish clear timelines and conduct regular re-evaluations to track progress and adjust the treatment plan as needed.


Choose our proven, patient-centred approach for effective, long-term relief from hammer toes.



 

References


  1. Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.

  2. Banta, H. D. (1997). Clinical Examination of the Musculoskeletal System: Assessing Rheumatic Conditions. 2nd ed. Springer. ISBN-13: 978-1850706817.

  3. Coughlin MJ, Dorris J, Polk E. Operative repair of the fixed hammertoe deformity. Foot Ankle Int. 2000;21(2):94-104.

  4. Frowen, P., O'Donnell, M., & Burrow, J. G. (2010). Neale’s Disorders of the Foot. 8th ed. Churchill Livingstone. ISBN-13: 978-0702031717.

  5. Klein EE, Weil L Jr, Weil LS Sr, Knight J. Clinical examination of the foot and ankle. Prim Care. 2014;41(1):53–70.

  6. Klein EE, Weil L Jr, Weil LS Sr, Knight J. Hammertoes: Treatment and Surgical Options. Prim Care. 2014;41(1):53–70.

  7. Nix SE, Vicenzino BT, Collins NJ, Smith MD. Characteristics of foot structure and footwear associated with hallux valgus: a systematic review. Osteoarthritis Cartilage. 2012;20(10):1059–1074.

  8. Parekh, S. G. (2019). Foot and Ankle Examination and Diagnosis. Thieme. ISBN-13: 978-1626236882.

  9. Rome, K., & Brown, C. L. (2004). Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clinical rehabilitation, 18(6), 624-630.

  10. Schrier JC, Palmen LN, Verheyen CC, Jansen J, Koeter S. Hammer toe deformity and the outcome of total knee arthroplasty: a case-control study. Acta Orthop. 2014;85(6):614–618.

  11. Schrier JC, Palmen LN, Verheyen CC, Jansen J, Koeter S. Hammer toe deformity and the outcome of total knee arthroplasty: a case-control study. Acta Orthop. 2014;85(6):614–618.

  12. StatPearls, "Hammertoe." NCBI Bookshelf. Accessed on October 27, 2023.

  13. Wallace, G. F. (1982). Foot Examination and Diagnosis. 2nd ed. Butterworth-Heinemann Ltd. ISBN-13: 978-0723607576.

  14. Yates, B. (2008). Merriman's Assessment of the Lower Limb. 3rd ed. Churchill Livingstone. ISBN-13: 978-0443104683.


 

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DR. BRIAN ABELSON, DC. - The Author


Photo of Dr. Brian Abelson

With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.


As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.


A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.



 


MSR Instructor Mike Burton Smiling

Why Choose Our MSR Courses and MSR Pro Services?


Elevate your clinical practice with our Motion-Specific Release (MSR) courses and MSR Pro services, designed to provide a comprehensive, evidence-based approach to musculoskeletal care. Here’s why you should join us:


  • Proven Methodology: Developed by Dr. Brian Abelson, an international best-selling author with over 30 years of clinical experience, MSR integrates the most effective elements of osseous and myofascial therapies. With a success rate exceeding 90%, our approach helps set a new industry standard.

  • Comprehensive Training: Our courses blend rigorous academic content with innovative techniques. You’ll master essential areas like orthopedic and neurological examinations, myofascial treatment, fascial expansions, and osseous adjusting and mobilization.

  • Extensive Resources: As an MSR Pro subscriber, access a vast library of over 200 MSR procedures, fillable PDF forms, instructional videos, and in-depth articles. From patient intake to tailored exercise prescriptions, our resources equip you for clinical success.

  • Tailored Support: Refine your diagnostic skills and expand your treatment techniques with ongoing support through over 750 videos, including 200 technique videos, 250 exercise videos, and 160 MSK articles. This extensive library features over 50 musculoskeletal condition articles, all designed to support you in clinical practice. Our resources are dynamic, with regular updates to articles, technique videos, and new additions to our educational curriculum.

  • Innovation and Growth: We emphasize continuous learning and innovation, giving you the tools to adapt and thrive in complex clinical scenarios. Our courses and resources are designed to foster professional growth, keeping you at the forefront of musculoskeletal therapy.


Unlock your practice's full potential with our MSR courses and MSR Pro services. Achieve outstanding clinical outcomes and join a community of forward-thinking practitioners dedicated to excellence in patient care.




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