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Mallet toes and claw toes are similar to hammer toes, except that different joints on the toe are affected. The joint at the end of the toe buckles in a mallet toe, while a claw toe involves abnormal positions of all three joints in the toe. Hammertoes, mallet toes, and claw toes have similar symptoms and causes; therefore, treatments and preventive measures used to relieve hammertoe pain, frequently provide relief to painful mallet and claw toes as well.

Hammertoes are classified based on the mobility of the toe joints. There are two types:

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with changes in shoe styles and foot care products. But if left untreated, hammertoes can become more rigid and painful. Corns are more likely to develop as time goes on-and corns never really go away, even after trimming. In more severe cases of hammertoe, corn lesions may evolve into severe ulcerations. These lesions frequently occur in patients who have vascular disease or are Diabetic with neuropathy. The ulcerations can extend to the bone and result in infection and possible loss of digit or amputation.

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are heel spurs and plantar fasciitis.

A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur digs into the plantar fascia and causes small micro-tears in the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch.

Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a thick ligamentous/fibrous band on the bottom of the foot that is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is a painful inflammation of this band, which usually occurs at its attachment to the heel; however, the inflammation and pain of plantar fasciitis can occur anywhere on the plantar fascia.

Frequently the heel pain that is experienced is due to the presence of an ““adventitious bursa””. The bursa is a thin walled cystic like lesion that is meant to be a response to pressure and irritation. It is referred to as being ““adventitious”” as it is not anatomical. It is only present as a response to chronic irritation and pressure. When the patient steps down for first weight bearing the bursa is distended. Weight bearing compresses the bursa causing pain. As walking continues, the pain lessens somewhat. If overuse occurs, pain returns.

The chief diagnostic sign of these problems is pain in the bottom of the heel or arch when first standing, which gradually improves with walking. This pain may later return with continued walking. The pain usually subsides after a period of rest.

The treatment involves correcting the underlying causative problems. Please read the following sections for more information on the problem and its treatment.

The pain that is experienced with Iliotibial Band Syndrome is located on the outer aspect of the knee. It is not a pain felt within the joint, as it does not affect the knee joint itself. If you flex the knee about 30 degrees, and apply pressure to the outside of the knee with your fingers, and if you experience pain, then you may have Iliotibial Band Syndrome. Another way to test for this condition is to walk stiff-legged (not bending the knee); if this produces no pain but walking normally (bending the knee) does produce pain, then you may have Iliotibial Band Syndrome.

What is Iliotibial Band (I.T.B.) Syndrome? The I.T.B. is a thickened strip of fascia or muscle cover. It begins as a thick band that covers the outer thigh muscles, and travels down the outside of the leg to the knee joint, where it attaches to the outer edge of both the tibia and fibula, just below the knee joint. In so doing, the I.T.B. must lie against the protruding outer edge of the femur, just above the knee joint. As the knee is flexed and extended, the I.T.B. rubs against a thin fluid filled sac (a bursa), between it and the femur. The bursa acts to reduce friction, and to protect the I.T.B. However, when the bursa does not function properly, or there is a change in your running or cycling pattern, or a biomechanical foot or leg problem begins acting up, the I.T.B. becomes inflamed and painful.

Biomechanics: As an athlete runs or pedals a bicycle, flexion and extension take place at the knee. When the knee is flexed 30 degrees or more, the I.T.B. passes over the outer protruding edge of the femur, shifting posterior behind the edge of the femur. As the knee is extended, the I.T.B. passes back over the edge of the femur, and shifts anteriorly in front of the femur. It is this motion that commonly leads to irritation and pain of the I.T.B. and its protective bursa. If a biomechanical defect is present, such as bowlegs or pronation in the feet, the I.T.B. rubs against the edge of the femur with more force, causing greater irritation and pain.

A Neuroma, or Morton’s Neuroma, is a benign soft tissue mass that forms on the nerve that runs between the metatarsals, in the ball of the foot. It is not actually a tumor but a perineural fibrosis. There is a confluence of the medial and lateral plantar nerve between the third and fourth metatarsal heads and often at this junction the nerve is somewhat thicker. An intermetarsal neuroma can affect other spaces; the most common however is the third intermetatarsal space. The deep transverse ligament lies over this area and it is thought to apply some additional pressure. When two metatarsal bones rub together, they pinch the nerve that runs between them. This repeated pinching, or continuous minute trauma to the nerve, will cause the nerve to swell, and eventually a benign mass occurs at the site of the repeated injury. This mass is known as a Morton’s Neuroma (named after the physician who first described this mass, Thomas Morton in 1876).

Nail Fungus (Onychomycosis) is a progressive disease of the toenails and fingernails. Nail fungus is the most common cause of discolored, thick, and deformed toenails. Not all discolored and thickened nails are fungus infections. There are other conditions that will cause the nails to have a similar appearance i.e. psoriatic nail disease, dystrophic nails as maybe present in patients with compromised circulation. Toenails are affected more often than fingernails because the fungi that cause this disease thrive in the dark, warm, moist environment that is found in our shoes. Infected nails may first appear as a yellowish, white, or green discoloration of a small area of the toenail. If left untreated, the entire nail may eventually become discolored, thick, flaky, detached from the underlying nail bed; and an accumulation of dead, white, dry material may form between the nail and underlying nail bed. The infected toenails are usually not painful until the nail becomes so thick that it rubs against the toe box of the shoe.

What is a Fungus? Fungi (plural) belong to a group of primitive organisms that includes mushrooms, yeasts, rusts, and molds. The most common species of fungi that attacks the skin and nails of humans fall within the category known asdermatophytes. Dermatophytes are the parasitic fungi that attack and cause diseases of the skin and nails.

Rate of Nail Growth: Nails grow from the day we are born until we die. The rate at which nails grow becomes slower as we age; certain diseases, poor circulation, dietary deficiencies, some medications, and chemotherapy can also affect growth rate. Fingernails grow faster than toenails, at a rate of 3mm per month. It takes 6 months for a fingernail to grow from the root to the free edge. Toenails grow about 1 mm per month, and take about 12 months to be completely replaced.