Tuesday, July 25th, 2017
Strokes take a huge toll on the human body. They can cause anything from paralysis and speech loss to blurry vision, fatigue, and loss of mobility. Sadly, there is almost no part of the body that is completely safe from the effects of a stroke.
Post-stroke ailments cause a lot of physical and mental suffering. Some of the most common side effects are muscle spasms and pain, and stroke survivors can also feel weakness throughout an entire side of their body. One area that is often overlooked but is still a significant source of post-stroke pain is the feet—specifically, the toes. Individuals who have suffered from a stroke are often left to deal with claw toe or hammer toe.
These two conditions are often confused, but they impact different muscles in the foot.
Claw toe sounds just like its name. With claw toe, an individual’s toes are bent into a claw-like shape. This typically occurs with the four small toes on the foot, not the big toe. The smaller toes bend upward at the first joint, where the toe and foot meet, but at the middle joint and the joint closest to the tip of the toes, they bend downward. This creates a curled toe, partly arched upward but then angled downward, sometimes extreme enough to where the toe actually curls under itself.
Claw toe looks like a painful condition, and it is in certain cases. Some stroke patients report toe pain as a result of claw toe, but others are lucky enough not to experience any. However, even without toe pain, they might develop a callus from the toe knuckles rubbing against footwear, or from increased friction on the heel.
Hammer toe is a condition that occurs due to a muscle and ligament imbalance around the joint of the toe. Unlike claw toes, in which the toe is bent at all three joints, a hammer toe is bent at the middle toe joint. The toe becomes stuck in this position, causing pain and irritation. Because the toe is bent at the middle joint, it can sometimes look crooked, giving it a hammer-like appearance.
There are two types of hammer toe: flexible and rigid. Flexible hammer toes can be moved. If you are able to move your hammer toe, that’s a good sign because it means you caught it early and the problem is still mild. Rigid hammer toes, on the other hand, are present when tendons are too stiff to move. In this case, surgery may be required.
Many people find themselves with claw toes or hammer toes, and the causes can vary greatly. They can include the following:
Stroke. Strokes wreak havoc on the body, and the feet are no exception. The nerve and muscle damage caused by strokes can impact your toes. This results in the over-contracting of toes and spasticity, a condition where you lose control of the voluntary movement of your toe muscles.
Rheumatoid arthritis. Rheumatoid arthritis and other autoimmune disorders can cause the healthy tissues in a person’s joints to become inflamed, leading to joint problems.
Cerebral palsy. A congenital disorder that affects movement and muscle tone, cerebral palsy causes individuals to have muscles that are either too loose or too stiff. This occurs throughout the entire body, including the toes.
Diabetes. Diabetes, a disease in which the body has high blood sugar, can cause nerve damage. This nerve damage can take place in the feet.
Charcot-Marie-Tooth disease. Although rare, this hereditary disease causes nerve and muscle problems, which can result in weakness or deformities in the feet and toes.
Ill-fitting shoes. Claw toe and hammer toe aren’t always the result of a medical issue. Something as simple as the wrong footwear can bring about these problems. If you wear a poor-fitting shoe that forces your toes to stay bent for a prolonged period of time, and if you wear this shoe repeatedly, your toe muscles can tighten while your toe tendons shorten, making it difficult to straighten the toe even when you aren’t wearing the shoe.
While surgery is sometimes necessary for severe cases, many cases of claw toe and hammer toe can be improved with noninvasive and effective treatments. Rehab exercises can help your body re-learn how to control the foot muscles affected by claw or hammer toe. The more a stroke patient works on these rehab exercises, the more muscle control they will regain. With enough time and effort, the brain will allow you and your toes to relax and unclench. A few commonly used exercises for claw toe and hammer toe are:
This exercise helps establish greater flexibility. First, pull your toes downward. If you see the knuckles on your foot prominently popping up, you know you’re doing it correctly. You can also add gentle pressure to the arch of your foot with your thumb as your pull the toes down. Hold this stretch for 20 to 30 seconds. If you feel cramping in the arch of your foot, that’s a good sign—it means that your arch muscles are attempting to get stronger. Continue with this exercise until you begin to achieve greater flexibility. Step two of the exercise is to pull up on the tip of the toe once you have pulled down the toe as a whole. This helps to straighten the toe.
The marble pickup is exactly what it sounds like: simply put a bunch of marbles on the floor, and use your toes to pick them up and put them in a cup or bowl. This is a great way to loosen up the muscles in your feet and toes, and it’s more fun than typical foot exercises.
This exercise helps the intrinsic muscles that support the arch of your foot. Put a towel on the floor, and get into a sitting position. Put your feet on the towel, and curl your toes on the towel to try to scrunch and pull the towel toward you. Do 10 repetitions of this exercise. Then, use your toes to stretch the towel back out, away from you.
Toe taps are a great exercise for helping to stretch the joints in the foot and toe. Sit down with your feet flat on the floor. Point your big toe toward the floor while trying to point your other four toes upward. Hold for a second or two, then tap your toes on the floor and repeat. Continue this “tapping” process 10 times, and then reverse the exercise and do it 10 more times, but now keeping your big toe pointed up and your other toes pointed down.
These exercises can greatly benefit stroke patients with claw or hammer toes, but if you don’t see an improvement in your pain levels or your pain gets worse, or if you start to notice a sore developing on your toes, be sure to call your doctor. In some situations, surgery might be necessary. But surgery is only required in the most serious cases—if you can’t move your toes at all or if your toe issues are severely hindering your day-to-day activities.
Claw and hammer toes can be a painful post-stroke condition, but they’re a common problem, and there are steps you can take to fix them. By exercising your feet and toes, you can help relieve the discomfort and get your feet back on the path to recovering their pre-stroke form.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.