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.

Introducing Dr. Daniel Yeaman

I am pleased to announce that Daniel Yeaman, DPM has joined our team at Shenandoah Podiatry. A native Virginian, Dr. Yeaman recently completed an extensive fellowship in diabetic wounds and limb salvage following a three-year residency, specializing in reconstructive foot and ankle surgery.

His specialties are management and reconstruction of the diabetic foot and ankle. He also treats ingrown nails, skin conditions of the foot such as plantar warts, fungal nails and painful foot conditions such as heel spurs.

He has traveled to Honduras to assist in surgery for children born with foot deformities such as clubfeet and has volunteered locally throughout his education.

In his free time, Dr. Yeaman enjoys hunting, fishing and spending time with his family.

We strive to provide the best care possible for our patients and feel his addition will contribute greatly to our efforts. Please welcome Dr. Yeaman as we all work towards your good health.

Dedicated To Your Healthy Feet,

Dr. Jennifer Feeny

Podiatric Medicine Helping Dorenzo Hundson and the Virginia Tech Hokies

Dorenzo Hudson has been a star on the basketball court for the Hokies this season but unfortunately even stars fall sometimes. On January 16^th at the Florida State vs. Virginia Tech game, Hudson suffered from a stress related bone bruise and has been dealing with the injury ever since. Even still, this junior point guard has not let that affect the amount of points he has been racking up at every game. Just one week after he bruised his bone he scored the winning basket at the Boston vs. Virginia Tech game. He has kept his game points very high to everyone’s delight. This injury has not caused Hudson to miss a game yet, although he did have to miss practice this week and sit out a few minutes during the game against Maryland on Feb 27th. Hudson has been a huge part of the Hokies success this season and this injury has kept everyone on the edge of their seat, just hoping that it won’t take their star out of the game. Luckily with trainers, podiatric medical equipment (an orthopedic ankle brace and an immobilization boot), rest, and an amazing amount of determination on Hudson’s part, he has kept his game strong and will hopefully carry the Hokies to the NCAA championship.

King Tut's Club Feet

When we think about world rulers, the ones who changed history, we usually concentrate on the changes they’ve done rather than think about the human aspects of their lives. Recent CT scans and DNA tests reveal a lot about the great Boy-King of Egypt’s very human life. They found out that he had club feet, Kohler’s disease, and a cleft lip just to name a few, yet he went on to rule the empire of Egypt for 10 years from 1333 B.C. until his death at the age of 19.

It is amazing to see that he was able to rule such a great empire with these ailments despite the physical pain that they cause and also though they caused visual changes in him as well. Club foot is a congenital deformity in which the foot turns inward and downward at birth causing that outer side of the foot to become the area that is walked on. Kohler's disease is a condition, where the navicular bone in the foot undergoes avascular necrosis. Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. Both of these ailments are very painful and make it extremely difficult to walk.

Often people have a hard time following leaders if they seem physically weak but King Tut was able to pull it off despite being in pain everyday and having to use a cane to walk. It is inspiring to know the lives that people have lead even with foot pain but makes me so thankful that we now have podiatrists and don’t have to live it foot pain!!

Fun fact: Over 130 walking sticks where found in King Tut’s tomb.

Olympic Feet

With the winter Olympics going on right now, it makes me think of all the different sports we are able to participate in. Sports that ask us to run, jump, kick, twist, turn, and glide. Sports that ask for speed and agility that, without the versatility of our feet, would not be possible or at least would look quite a bit different!

The 26 bones and 33 joints in each foot allow us to effortlessly become mobile in many different ways. When I see someone skate their heart out down the length of the ice and stop on a dime, my breath is taken away. Though it may seem like the boot is doing the work, anyone who has ice skated before and had sore feet the next day will tell you otherwise. The complexity of the foot is amazing. And even more amazing than that are the mechanics that make a human foot work properly, the podiatrist.

Though feet are not visible during the winter Olympics, they are still a very important part of the games. A ski or a skate is merely an extension of the foot. Bobsledding wouldn’t be possible without the help of our feet mustering up enough momentum to make the sled go. Even changing the balance and placement of your feet in curling can change your game.

During the 2010 winter Olympics root for team feet! And keep in mind all the amazing things your feet do for you everyday.

Though we are all about feet, we want to recognize those who haven’t given up the games they love because their mode of movement is different than the movement of the original game. We want to recognize how these sports have been modified to work for all kinds of people. For more information about wheelchair and ambulatory sports check out http://www.wsusa.org/.