Condition Information

Possible types of crooked toes include:

1. Hammertoe: A hammertoe is a crooked toe that is flexed (bent down) more than it should be at your first toe joint (proximal interphalangeal joint). Oftentimes the toe is also extended (lifted up) at the joint that connects the toe to the foot (metatarsophalangeal joint). Hammertoes may affect any of your toes, and they often begin as mild deformities that can become more severe over time. Hammertoes are usually flexible in the initial stages but may become rigid if they are not treated appropriately.
2. Claw toe: A claw toe is a crooked toe that is flexed more than it should be at both your first (proximal interphalangeal) and second (distal interphalangeal) toe joints. If you have a claw toe, your involved toe may dig into the soles of your shoes, causing painful calluses to develop. This crooked toe problem usually gets worse without treatment and may cause irreversible deformities over time.
3. Mallet toe: A mallet toe is a crooked toe that is flexed at your last toe joint (distal interphalangeal joint) only. The rest of your toe is straight. A mallet toe is commonly caused by shoes that are too tight in the toe box or shoes that possess high heels. The forces these shoes place on your feet cause unnatural bending of your toes.
   
4. Overlapping toe: This condition occurs when one toe sits on top of another toe. The most commonly affected toes are the second and fifth toes. When a bunion causes the big toe to crowd the second toe, the second toe can begin to form a hammertoe that causes the second toe to overlap on top of the big toe. This can result in rubbing, leading to callusing and wounds. Similarly, the fifth toe will sometimes overlap on top of the fourth toe if shoes with a narrow tapered toe box are often worn.
5. Adductovarus toe: Similar to an overlapping toe, adductovarus toe is a crooked toe that has moved under its adjacent toe. This toe problem is commonly associated with bunionettes, seen in your fourth and fifth toes, and it is a direct result of wearing shoes with tapering toe boxes. This condition is seen to some degree in most shoe-wearing people. Unshod individuals—people who do not wear shoes or conventional footwear—do not experience this health problem.
6. Curly toe: Curly toe,  is a crooked toe in which the most distal part of your toe—the toe segment located furthest away from your body—is flexed and curved to one side of your foot. Curly toes may be particularly common in newborns, and most curly toes spontaneously resolve before age six. In some cases, however, curly toes may cause pressure symptoms in shoe-wearing individuals later in life.

Causes and Symptoms

Inappropriate footwear is the leading cause of crooked toes. Footwear that possesses heel elevation, rigid soles, tapering toe boxes, and toe spring may force your toes into unnatural positions and encourage muscle or tendon imbalances in your feet and lower extremities. In some cases, crooked toes may be associated with past foot trauma. Genetics may play a role in this health problem in some individuals, too.

Some of the most frequently experienced symptoms associated with crooked toes include:

• Toe pain or irritation when wearing shoes
• A thickening of the skin between your toes, on the ball of your foot, or elsewhere
• A burning sensation in your affected toe
• Inflammation and redness
• Toe contracture, or permanent toe shortening
• Open sores

How to Fix Crooked Toes

To learn how to straighten a toe, you should visit a podiatrist or other appropriate healthcare professional if you are experiencing any of these crooked toe syndromes. Your physician can provide you with strategies to help reduce the progression of your crooked toe problem. The longer your crooked toe problem exists, the greater the likelihood it will become permanently rigid and require more extensive—and invasive—treatment, including surgery. Seek natural foot health professionals that specialize in conservative care before opting for surgery,

Physical therapy, toe joint manipulation, and stretching of the muscles and tendons surrounding your toes may provide some reduction of your deformity. Instrument-assisted soft tissue mobilization—Graston, gua sha, scraping—may also be helpful for this health purpose. Stretches that target your crooked toe problem involves both your intrinsic foot muscles and major foot flexor and extensor muscles and tendons in your lower leg. The toe extensor stretch and these 5 foot strengthening exercises can be helpful home exercises to address crooked toes.

You should avoid wearing shoes that possess heel elevation if you have crooked toes. High-heeled shoes, including most running shoes, will hasten the progression of your crooked toe, as this design feature creates an imbalance in your foot flexor and extensor muscles as well as the four layers of muscles within your foot. These intrinsic foot muscles help stabilize your toes during walking and standing.

Every attempt should be made to spread your toes when you are barefoot. A toe-spacing product, such as Correct Toes, can be worn inside foot-shaped shoes with a toe box widest at the end of the toes or with your bare feet to help reapproximate your toes to the correct anatomical position, strengthen the muscles and tendons that attach to your toes, and increase the stability of your forefoot.

Surgery, when required, is used to help straighten your crooked toe and balance the pull of tendons surrounding your toe. Pins or wires are sometimes required to keep your toe in its correct position while it is healing. Note that surgery may not provide a complete correction of your crooked toe, and your problem may return if you continue to use the footwear that contributed to your condition. Ask your podiatrist about the risks, benefits, and limitations of toe surgery to help resolve your crooked toe problem.

Sandals can also help with improving and maintaining good foot hygiene. While the upper of a conventional shoe or boot will trap heat and moisture inside, the openness of sandals does the opposite. Fungal skin & nail infections, like Athlete’s foot and fungal toenails, thrive in dark, damp, warm environments. Open airflow and splayed toes help to evaporate excess moisture from sweat, helping prevent foot odor that comes from fungal and bacterial growth on the skin. Additionally, UV rays from sunlight help to kill fungal infections of the skin and nails.

Transition Barefoot Sandals – 9 Best Barefoot Sandals

If your feet are used to supportive shoes and sandals that have arch support and cushioning and are generally stiffer/less flexible, then barefoot sandals and minimal sandals might challenge your feet to work harder than you’re used to. Transitioning to best barefoot sandals can help guide you to safely build stronger, more functional feet. A transition barefoot sandal will have a thicker sole and less flexibility than a barefoot sandal or minimal sandal. Barefoot sandals with a stack height from about 9 mm to 15 mm are typically a safe starting point for most people. Active sandals designed for hiking and trail running with deeper tread and lugs tend to be great barefoot transition sandals.

Active Barefoot Sandals for Hiking and Running

Luna Mono Winged (15 mm)

Luna Sandals (Seattle, WA) is one of Correct Toes’ all-time favorite sandal brands. Barefoot Ted, the founder of Luna, was inspired by the huarache sandals worn by the legendary Tarahumara tribe of the Copper Canyons in Northern Mexico. The Tarahumara are exceptional runners that run through winding canyons in simple sandals. The story is famously chronicled in Christopher McDougall’s best-seller, Born To Run. 

The Luna Mono Winged is a trail-running sandal with a 15 mm thick treaded Vibram sole. A single adjustable strap attaches between the big toe and second toe and runs around the outside of the ankle, heel, and inside of the ankle, before fastening back on top of the midfoot. These sandals are secure to the foot and perform incredibly well on all terrains.

Shamma Chargers (9 mm)

Shamma Sandals (Santa Cruz, CA) started with a simple idea: make minimalist sandals that were suitable for running. Shamma Sandals is a small, family-owned and operated business that believes running is the standard for human movement. The Chargers have a 7-8 mm thick sole without tread and about a 9 mm stack height altogether. There are two adjustable velcro straps — one on the heel and one on the inner midfoot — to help create the perfect fit. Check out Correct Toes interview with Shamma Sandals.

Bedrock Cairn Adventure (14 mm)

Bedrock Sandals (Missoula, MT) were made for people looking for a lighter-weight, more freedom-feeling sandal for our outdoor and everyday needs. The award-winning Cairn Adventure sandal is built on a 14 mm Vibram XS Trek Regolith Outsole. The exclusive strap system with three adjustment zones and a super comfortable toe post is really what sets these sandals apart. They come in a bunch of different colors so you can express yourself while on hiking trails, bike tours, or just kicking around town.

Casual Barefoot Sandals for Walking and Leisure

Ahinsa Comfort Sandals 

Ahinsa Shoes (Czech Republic) are made by physiotherapists who were seeking healthy, high-quality, and ethical shoes. As physiotherapists teaching people to walk and move better, the team at Ahinsa came to the same conclusions as many others in the natural foot health world: it’s impossible to improve foot health without healthy footwear. So Ahinsa focused on making light, flexible barefoot shoes that stimulate the feet to become stronger and more functional. Ahinsa has two versions of their shoes: “barefoot shoes” that are minimally supportive, and “comfort shoes” that have a little more cushion to help people transition until they’ve learned how to walk healthy. Ahinsa Comfort Sandals are cushioned with ultra-lightweight cork added to a durable, non-slip outsole. Check out the Correct Toes interview with Ahinsa Shoes.

Minimal Barefoot Sandals

Minimal barefoot sandals are best for feet that are used to spending time barefoot or wearing unsupportive shoes. These sandals simply protect the soles of your feet, yet still allow them to function as nature intended. Walking, running, and hiking in minimal sandals are some of the best ways to strengthen muscles to build resilient feet and legs.

Active Barefoot Sandals for Hiking and Running

Xero Z-trek (6 mm)

Xero Shoes (Boulder, CO) were also inspired by Christopher McDougall’s best-selling book Born to Run.  Xero founder Steven Sashen is a sprinter who struggled with injuries and long-distance runs until he dove into the barefoot running world. Xero started out with simple huarache-style sandals made of Vibram rubber and cord and now has a robust catalog of sandals, shoes, and boots. The Z-Trek has a “Z” strap that crisscrosses the top of the foot with no toe post or thong between the big toe and second toe. It’s super lightweight and built on a 6 mm FeelTrue sole with chevron tread. From the trail to the city, on water and on land, set your feet free with Z-Trek.

Shamma Cruzers (6 mm)

Shamma Cruzers are the Shamma Chargers’ more minimal sibling. With an even lighter 6 mm outsole, the Cruzers lacing system uses an entirely new buckle that locks the strap into place keeping adjustments secure and the Powersleeve keeps the heel strap up and in its proper position. This best barefoot sandals are great for walking, hiking, and running on the streets, the mountains, and the trails.

Casual Barefoot Sandals for Walking and Leisure

Feelgrounds Pathway (6.5 mm)

Feelgrounds (Germany) was founded by a young team to make the best  barefoot shoes that are stylish and cool. All of their shoes are vegan (100% animal-free) and they use recycled materials whenever possible. As a member of the European Business Social Compliance Initiative, sustainability, fairness, and transparency are essential values for Feelgrounds. The Pathway is one of two sandal options for this growing company. It features two adjustable hook and loop cushioned straps at the heel and instep, which can accommodate a variety of foot shapes, ensuring a personalized fit.

Vivobarefoot Opanka Sandal (4 mm) — Tan / Obsidian

Vivobarefoot (London, England) was founded by two seventh-generation cobblers based on one simple insight — barefoot footwear is regenerative to human health. Vivobarefoot is a certified B Corp that meets the highest verified standards of social and environmental performance, transparency, and accountability. Recycling and sustainability are paramount for Vivobarefoot and its diverse catalog of both active shoes and casual shoes. The Opanka sandals waste not — their premium leather comes from production scraps of other projects. The natural rubber 4 mm barely-there sole provides the ultimate fit, feel, and flexibility for natural stability, sensory feedback, and strength.

Be Lenka Grace (4 mm) 

Be Lenka (Slovakia & Czech Republic) believes in “slow fashion” and encourages their customers to buy less often and choose quality products. Each pair of Be Lenka barefoot is precisely cut and put together by local skilled craftsmen using only the highest quality material. All Be Lenka barefoot shoes aim to have four key features: a wide toe box, flexible & thin soles, a “zero drop” sole, and as lightweight as can be. The Be Lenka Grace is one of the best barefoot sandals because of its elegant and trendy leather design with adjustable leather straps to ensure all-day comfort.

Barefoot Sandals and Toe Spacers

Did you know you can wear Correct Toes with sandals? Correct Toes can be an incredibly helpful tool that helps promote healthy toe alignment while engaging the foot muscles to strengthen. The wide toe splay that Correct Toes help achieve creates stability in the toes and forefoot, making it much easier for the rest of the foot (like the arches) to function properly. Correct Toes are an ideal tool for aiding the transition process from supportive footwear to minimal and barefoot sandals. You can even wear toe spacers with barefoot shoes; flip flops and other sandals that feature a thong strap or toe post.

The use of ice for treating medical injuries originated in the 1960s when it was used to preserve the tissue of a severed limb. A remarkable medical breakthrough occurred when a 12-year-old boy became the first person to have a major limb (arm) successfully reattached to his body. The news of this successful procedure quickly spread around the world, capturing public attention. However, as the story was retold by those not directly involved in the surgery, some details were altered and complex medical concepts were simplified for the general public. Over time, one documented case of successfully using ice for tissue preservation prior to limb reattachment surgery was mistakenly generalized to applying ice to all types of injuries to facilitate healing. This belief continues to be widespread even today.

Inflammation, Swelling, and Repair

The RICE protocol aims to combat or stop inflammation and swelling. Many people perceive inflammation as a harmful process that needs to be stopped as soon as possible. However, inflammation is actually a necessary and crucial part of the body’s initial response to injury. It helps control the injury at a cellular level and prepares the tissues for the next phase of healing. Inflammation is followed by a repair phase which is then followed by a remodeling phase, and each phase must come to completion before the next phase can begin. Inflammatory cells trigger blood vessels to open and increase their permeability, which allows healing cells to access the injury and start the repair process. Attempting to limit or suppress inflammation can interfere with this process and result in chronic inflammation.

As the inflammatory phase comes to a close, excess fluid waste (swelling) is cleared through a series of channels throughout the body called the lymphatic system. Lymph vessels rely on movement from nearby skeletal muscle contractions to propel fluid along their pathways. Therefore, muscle contractions are necessary to facilitate the reduction of swelling. Immobilizing the injured area prevents movement and muscle contraction, hindering the lymphatic system’s ability to reduce swelling, which in turn delays tissue repair and increases the risk of chronic inflammation. 

The main issue with inflammation is not necessarily its intensity but rather the interruption or delay of the process and inadequate clearance of inflammatory fluid. In many cases, inflammation does not need to be suppressed, reduced, or delayed, especially in acute situations. Instead, it should be encouraged to run its course efficiently. Optimal inflammation is a swift and strong response that sets the stage for tissue repair. Once the excess fluid is cleared, the repair phase begins by forming new healthy tissue and establishing new blood vessels to deliver oxygen and nutrients to the area. This is followed by the remodeling phase, which relies on adequate blood supply to develop and strengthen the newly formed healthy tissue.

Ice and Immobilization Interrupt Inflammation and Delay Healing

Applying ice to an injury causes the local blood vessels to narrow, reducing blood flow and limiting the movement of inflammatory cells and their signals. This vasoconstriction can persist even after the ice is removed, leading to a low-oxygen environment that hampers healing. Furthermore, ice suppresses the release of IGF-1, a hormone that plays a crucial role in the healing and regeneration of muscles and other injured tissues. Considering these effects, it becomes clear that cold application slows down the healing process.

Resting, particularly by avoiding putting weight on the injured area, can be necessary to prevent further damage. However, it does not actually enhance or accelerate the recovery process. As mentioned before, the lymphatic system relies on muscle contractions to remove waste products from the injured area. Immobilizing the injured area can result in congestion and stagnation, impeding the drainage of excess fluid. This prevents the completion of the inflammatory phase, which in turn hinders the progression to the repair and remodeling phases of healing.

Elevation & Compression

There isn’t strong evidence specifically analyzing the effectiveness of elevation as a post-injury measure. However, it can be beneficial for some individuals. If elevating an injury feels good—go for it, but there’s no need to force it if it doesn’t provide relief. The main purpose of both compression and elevation is to reduce swelling, which can be appropriate in certain situations but should not be the sole focus. Non-rigid braces and compression sleeves can temporarily reduce swelling by physically compressing the affected area. This can alleviate pressure on nearby nerves, reduce pain signals, and improve joint mobility and range of motion. Compression is particularly useful during the rehabilitation and strengthening phases of post-injury recovery, facilitating a smoother transition back to activity. Compression sleeves work great for the ankle, calf, and knee.

Anti-Inflammatory Medications

In addition to the RICE protocol, anti-inflammatory medications such as NSAIDs (e.g., Ibuprofen, Motrin) are commonly recommended for managing musculoskeletal injuries. It’s important to understand how these medications work so that you can align their use with your healing goals. NSAIDs function by blocking the production of prostaglandins, which are responsible for initiating inflammation. Consequently, they can temporarily reduce inflammation, as well as alleviate pain and swelling. However, as we’ve discussed earlier, inflammation plays a vital role in the healing process. NSAIDs can interfere with fracture healing and impede proper tendon healing following tears. Acetaminophen (Tylenol) works differently from NSAIDs. It primarily helps to reduce pain and fever without significantly affecting the inflammatory process.

However, it’s essential to recognize that masking pain signals can have its drawbacks. Pain serves as a valuable warning sign, alerting us when we may be damaging or injuring ourselves. By suppressing pain, we lose this awareness and run the risk of further injury. Moreover, like many other medications, NSAIDs can have various side effects, but discussing them in detail goes beyond the scope of this article.

HEAT, PEACE & LOVE

We love our acronyms, and if RICE won’t cut it, you can consider alternative approaches like “HEAT” or “PEACE and LOVE.” HEAT stands for Heat, Exercise, Analgesics, and Topicals. Ice can be useful immediately following an injury to help temporarily numb the pain and slow down any potential excess bleeding into the surrounding tissues, but for many injuries, the actual bleeding stops within minutes to hours after the initial injury. Starting within 24-48 hours after most injuries, heat alone or intermittent cold alternating with heat applications (5-10 minutes at a time) can be used to help reduce the potential for stagnation and congestion while encouraging adequate healthy blood flow. Good circulation is crucial for healing, especially in less vascularized areas like ligaments, tendons, joints, and fascia. Heat can also temporarily relieve pain for some individuals.

The “E” in HEAT stands for Exercise. It involves starting with gentle movements and general exercises aimed toward improving the range of motion, gradually progressing to dynamic movements and strengthening exercises as the injury heals. Strengthening the muscles around the injured area supports full functionality and reduces the risk of future injuries.

Analgesics and Topicals are methods to alleviate pain. If optimal tissue healing is your goal, it’s often best to avoid NSAIDs if possible. Sometimes natural supplements like turmeric can help to modulate inflammation. Topical treatments containing menthol, camphor, and capsaicin can effectively reduce pain and encourage exercise. Topicals are particularly suitable for foot and ankle injuries, as the affected structures are often close to the skin surface. One example of a topical treatment is Sombra, used at Northwest Foot & Ankle.

PEACE is a thoughtful approach for immediately following an acute injury and stands for Protect, Elevate, Avoid anti-inflammatory modalities, Compress, and Educate. Patient education is crucial for long-term success. On the other hand, LOVE guides the rehabilitative aspect of recovery, standing for Load, Optimism, Vascularization, and Exercise. When resuming activity, it’s important to manage the load and avoid overexertion to prevent re-injury. Optimism, along with education, plays a significant role in successful treatment outcomes. It’s essential to recognize that we are our own best healers, and rather than impeding or suppressing our natural healing processes, we should learn to support and facilitate them. For more information about how to help heal your specific injury, please consult with your holistically-minded physician or reach out to us at Northwest Foot & Ankle.

Sources

1. 1. Scialoia, D. The R.I.C.E Protocol is a MYTH: A Review and Recommendations. The Sport Journal. 2020. Vol. 22.
2. 2. Lin CW, Hiller CE, de Bie RA. Evidence-based treatment for ankle injuries: a clinical perspective. J Man Manip Ther. 2010;18(1):22-28. doi:10.1179/106698110X12595770849524
3. 3. Su B, O’Connor JP. NSAID therapy effects on healing of bone, tendon, and the enthesis. J Appl Physiol (1985). 2013;115(6):892-899. doi:10.1152/japplphysiol.00053.2013
4. 4. Weerasekara RMIM, Tennakoon SUB, Suraweera HJ. Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains. Foot & Ankle Specialist. 2016;9(4):307-323. doi:10.1177/1938640016640885

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.

If you’re an athlete, someone struggling with foot pain, or just curious about the benefits of toe separators, you should keep reading. 

In this article, we will explore the personal and product-related factors that influence the success of toe separators. We’ll dive into what you need to know to unleash the full potential of toe separators and get back in the game.

As Early As One Week

When used properly, toe separators can deliver some amazing results. In the first 1-2 weeks, expect improved foot and ankle stability due to improved structural alignment. Minor aches and pains may start to fade away within days or weeks, however, you expect some muscle and joint soreness as the toes adjust and previously inactive muscles become more engaged. But don’t worry, it’s a sign of progress! 

Over the next few months to a year, you’ll start to experience enhanced toe dexterity, increased foot and toe muscle strength, and relief from more bothersome aches and pains. And with consistent use for years, many will be able to eventually see significant long-lasting changes in their foot strength and appearance, as well as relief from significant aches and pains.

Personal Factors That Affect Toe Alignment

The current health status of an individual’s feet plays a crucial role in estimating the timeline for foot and toe rehabilitation using toe separators. Feet with severe bunions, bunionettes, and hammertoe deformations will require more time to recover compared to feet with less severe problems.

Ideally, a healthy foot has all the toe bones in alignment with their respective foot bones. The greater the angulation between the toe and foot bones, the more corrective work is necessary to realign them. 

Additionally, an individual’s foot health goals, whether focused on pain reduction, muscular development, or aesthetic improvements, will influence the target endpoint of the treatment. 

Even if complete reversal isn’t always possible, you can still experience improved stability, reduced pain, and enhanced foot function. It’s all about setting realistic goals and having the patience and dedication necessary to achieve them.

Genetics, age, and overall health also come into play. While bunions and similar toe deformations are not hereditary, the properties of the musculoskeletal system inherited from one’s genes can contribute to a predisposition for bunion formation. Factors such as ligament and muscle laxity, fascia elasticity, bone shape/size, and inherited gait patterns can impact the potential for bunion development. 

Additionally, as we age, the body’s capacity to heal, repair, and rebuild itself slows down, necessitating a longer timeline for the feet to change. You can’t change your genetics or turn back the clock, but that doesn’t mean you can’t make progress. Age might slow things down a bit, but it won’t stop you from getting back on track. 

Systemic diseases and body weight also influence the effectiveness of toe separators, making the path to recovery more challenging for individuals with conditions that affect the musculoskeletal system.

What to Look for in Toe Spacers

The choice of toe separators and their proper use are equally vital for successful outcomes. Not all toe separators are created equal, and considering certain product factors like qaulity of material is crucial. Look for toe separators made from high-quality, anti-microbial, medical-grade silicone. 

Some toe separators made from softer silicone may be more elastic but too squishy, and they may lack the necessary strength to effectively counteract stubborn bunions. Correct Toes toe spacers, on the other hand, provide the perfect mix of resistance and comfort, giving you the best shot at success.

An anatomical fit is another critical aspect of toe separators. Correct Toes are designed with your unique feet in mind to anatomically space the toes in alignment with the foot bones, offering four different sizes that can be further customized for optimal results. 

In contrast, other toe separators that are one-size-fits-all are not likely to align all toes properly, leading to potential harm rather than benefit.

Success with toe separators also depends on how you use them and for how long. Consistent wear and engagement in weight-bearing activities while wearing the toe separators are key. 

Start with 30 minutes a day and work your way up, gradually increasing wear time by 30 minutes per day and progressively engaging in weight-bearing activities like walking, running, hiking, yoga, or hitting the gym. Take it slow to start, but once you’re comfortable, the more you move, the faster you’ll see results.

It is important to note that toe separators may not be effective when worn with conventional shoes that have narrow, tapered toe boxes. So, choose shoes with a wide toe box that are compatible with toe separators and give your toes the space they need to spread out comfortably. 

The Shoe Liner Test is a great way to evaluate footwear. Stand upon your shoe’s insole with toe separators on to see if that shoe’s toe box is wide enough to fit your toe separators.

Additional exercises can complement your toe separator journey. Some great mobility exercises include interlacing fingers between toes, the bunion stretch and soft tissue release, the toe extensor stretch, and rolling the bottom of the foot on a lacrosse ball. 

And here are 5 foot strengthening exercises that pair well with toe separators. These exercises, combined with toe separators, can accelerate your progress and improve overall foot health.

Toe separators can be valuable tools in realigning and strengthening the feet, providing relief from foot discomfort, and contributing to overall foot health. However, success with toe separators requires dedication, patience, and consistent effort. 

By considering personal factors such as foot health status, goals, genetics, age, and overall health, along with product factors like material quality and anatomical fit, individuals can make informed decisions and optimize their chances of achieving positive outcomes with toe separators. 

Remember that the process of foot rehabilitation is gradual, and progress may vary, but by applying the insights shared in this article, individuals can tip the scales in favor of success.

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.

In the late 2000s, a barefoot running renaissance emerged, capturing the attention of runners and fitness enthusiasts alike. Vibram FiveFinger “toe shoes” and Christopher McDougall’s bestselling book, Born to Run, fueled the belief that running barefoot or in barefoot-mimicking shoes could enhance foot and leg strength, reduce injuries, and improve overall resilience. Who wouldn’t want stronger, more resilient feet?

Transitioning to Barefoot Shoes

The transition from conventional running shoes to minimal footwear proved to be more challenging than anticipated. Many individuals excitedly discarded their bulky, motion-controlling shoes and jumped straight into training barefoot or with minimalist footwear like Vibrams. 

While liberating, running barefoot requires a different level of skill, strength, and awareness compared to traditional running. Surprisingly, even accomplished runners found the gap between their ability to run barefoot or in minimalist shoes and their performance in modern maximalist shoes to be substantial. Without a gradual and thoughtful transition, the risk of injury loomed large.

Unfortunately, society’s obsession with immediate results often overlooked the importance of gradually strengthening and mobilizing the feet to handle increased workloads. This became evident when Vibram faced a class-action lawsuit, with plaintiffs accusing the company of making false health claims regarding their FiveFinger toe shoes. Although subsequent studies demonstrated that training in Vibram FiveFingers did indeed strengthen intrinsic foot muscles, there were no available studies at the time of the lawsuit.

The majority of conventional footwear, including running shoes, features design elements like tapered toe boxes, toe springs, and heel elevations. While intended to correct foot stability, these features inadvertently interfere with the foot’s natural function, hindering the big toe’s ability to push off and leading to an overpronated posture and flattened arches. 

In response, shoes are now equipped with built-up arch supports and motion-controlling features. However, the more external support shoes provide, the less opportunity there is for the feet to develop internal strength and stability. Feet that rely excessively on support can become dependent on shoes with stabilizing features, ultimately weakening and deforming due to the footwear’s design and technology.

The Impact of Wearing Conventionally-shaped Shoes

Over time, wearing conventionally-shaped shoes can result in muscle imbalances and foot deformations. A tapered toe box squeezes the toes together, weakening the muscles on the sides of the foot while tightening those in the middle. This imbalance can lead to the development of bunions and hammertoes. 

Similarly, heel elevation and toe spring lengthen and weaken the muscles on the bottom of the foot while shortening and tightening the extensor muscles on the top. Consequently, many people live with feet shaped by their footwear—restricting their ability to move effectively without external assistance.

Consider this thought experiment: imagine a boxer who keeps their hands constantly wrapped in boxing gloves. Although protected from injuries, their finger strength and coordination may not be sufficient to perform delicate tasks like playing the piano or using chopsticks. 

Similarly, expecting dysfunctional and dependent feet to handle the rigors of barefoot running or minimalist shoes immediately is unrealistic. Regaining foot function requires more than just switching to naturally-shaped footwear; it often necessitates reversing damage and retraining the foot.

Toe Correcting Solution

This is where Correct Toes comes into play. Similar to braces for teeth, Correct Toes gradually guide micro-changes toward optimal toe alignment. By splaying the toes back into their natural wide position, Correct Toes help reverse muscle imbalances caused by narrow toe boxes. 

Proper toe alignment provides natural support for foot arches, improves balance, eliminates overpronation, optimizes weight distribution, and promotes optimal circulation, among other benefits. The alignment of the big toe is particularly crucial for walking and running, as it bears a significant amount of weight and plays a key role in pushing off the ground for the next step. When the big toe is misaligned, as often seen in bunions or tapered toe boxes, its ability to effectively extend and push off becomes compromised, leading to compensatory patterns and reduced functionality.

While wearing Correct Toes during activities helps train the toes and foot muscles to operate in healthy alignment, complementing their effects with targeted exercises and manual therapies is highly beneficial. The bunion stretch and soft tissue release, for example, helps realign the big toe by loosening tender spots between the foot bones and releasing tight muscles. 

Similarly, the toe extensor stretch lengthens the tendons on the top of the foot, which are often tightened by shoes with toe spring and heel elevation. By addressing these issues, it becomes possible to effectively strengthen the weak muscles on the bottom of the foot. Additionally, using a lacrosse ball or massage ball to encourage plantarflexion can help bring the toes back to a flat position.

The foot is an elegantly designed structure, capable of supporting and moving our body weight for a lifetime. Its three arches provide strength and adaptability, allowing us to navigate various surfaces. However, when one end of an arch is displaced, instability arises, and the foot struggles to maintain its integrity. These arches must be both strong and flexible to function optimally, efficiently transferring energy.

Barefoot Shoes and Toe Spacers for Optimal Foot Health

To experience the full benefits of being barefoot or wearing minimalist shoes, the foot must be in a position and posture that can naturally support itself—flat with toes splayed in alignment. Simply switching to footwear shaped like feet is a significant first step, but for those who have worn conventional footwear for an extended period, addressing muscle imbalances and retraining the foot is often necessary. 

Correct Toes, combined with targeted exercises and manual therapies, helps encourage a healthy foot posture and facilitates a smoother transition to barefoot shoes, enabling you to achieve optimal foot health and continue moving forward with confidence.Unlock the potential of your feet and embrace the strength and functionality they are meant to possess. Transitioning to barefoot shoes is a transformative journey that requires patience, dedication, and the right tools. 

By incorporating Correct Toes and holistic foot care practices, you can embark on a path toward healthy, resilient feet that will support you for years to come. Get ready to experience the joy of movement and discover the true potential of your remarkable feet.

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.

Do you have a bunion? Probably a little bit.

Many people have at least a very slight bunion due to the unfortunately ubiquitous Tapered Toe Box shape that’s designed into virtually all mainstream and conventional footwear. It’s not just dress shoes, cowboy boots, and stilettos that are too narrow, most casual and athletic footwear, including running shoes, basketball shoes, cleats, etc., are designed with this dysfunctional fashion feature. 

When you take enough steps in a shoe that squeezes your toes together, they start to learn to stay like that. Take a look at your shoes — do they come to a point in the middle? or are they shaped asymmetrically like a natural foot? A healthy foot shape should be widest at the tips of the toes with space between all toes, and all toe bones aligned with their respective foot bones.

Understanding Bunions

A bunion AKA hallux valgus is the progressive dislocation of the big toe laterally towards the lesser/smaller toes. [Hallux = big toe; valgus = points away from body’s midline]. If the bones in the big toe (phalanges) aren’t in straight alignment with the 1st metatarsal bone, this might be the very early stages of a bunion formation. 

Bunions happen progressively over time, so you don’t necessarily need to be in pain or have a huge bump on your foot to be forming a bunion—or to begin taking steps towards correcting it.

Bones of the human foot. Notice that even on this diagram the big toe isn’t quite in perfect alignment.

A bunion can be much more than a simple crooked toe. If left untreated, bunions can progress to extremely painful, debilitating, and at times disabling severities that significantly limit one’s ability to stand, walk, or move. 

6 Early Signs of Bunions

By taking proactive measures, you can gain valuable insights into the progression and severity of the condition, enabling timely intervention and appropriate management. If you think you might be in the beginning stages of a bunion, you need to take action now and watch out for these six bunion symptoms that are important to monitor. 

1. Bones are misaligned: With bones, we are referring to the alignment of the foot and toe bones. Pay attention to the changes in the alignment of the foot and toe bones, such as the big toe deviating towards the other toes or the metatarsal bone appearing more prominent on the inside of the foot.

2. Muscles are imbalanced: Muscle refers to the weak, tight, and over-stretched muscles that are responsible for holding the big toe in a “bunion position.” Notice if there is muscle weakness or tightness around the big toe joint, this may contribute to the misalignment and progression of the bunion.

3. Callus Formation: Skin callus formation can be a major clue to areas of increased rubbing, pressure, and friction. Observe the areas of the foot where calluses or thickened skin develop, particularly over the bony prominence of the bunion.

4. Reduced Range of Motion: Range of motion refers to how much movement one can get out of their big toe. Assess the flexibility and how easily you can move your big toe. Difficulty bending the toe or experiencing limited movement in certain directions, such as upward or downward, can be indicative of the early stages of a bunion.

5. Pain and Inflammation: With pain, it’s not just the severity, but also the quality, timing, and events associated with the pain. Consider the type of pain experienced. Bunions can cause dull, aching pain, or sharp and intense pain during activities or when wearing certain shoes. Note the frequency, duration, and triggers of the pain.

6. Forefoot and Arch Stability: Lastly, stability refers to the crucial role the big toe plays in stabilizing the f orefoot by maintaining the integrity of the 2 main arches of the foot: the medial longitudinal arch and the metatarsal transverse arch. Recognize that the big toe plays a crucial role in maintaining foot stability, notice any problems with balance, gait, and overall foot function.

Bunion Progression

Muscle imbalance (i.e. tight on one side and loose on the other) is the primary driver of early bunion formation. Fortunately, muscles respond well to rehab exercises and realignment training.

When it comes to bunions, the adductor hallucis muscle that attaches to the lateral side of the big toe (muscle body found mostly between 1st and 2nd metatarsals and into the central foot) becomes short and tight and thus pulls the toe laterally, pointing towards the 2nd toe. 

Consequentially the abductor hallucis muscle that attaches to the medial side of the big toe (muscle body found in the medial longitudinal arch) becomes elongated and loose, unable to oppose the adductor.

Adductor hallucis attaches to the lateral aspect of the big toe and is found mostly between the 1st and 2nd metatarsals. Abductor hallucis attaches to the medial side of the big toe and is found mostly in the medial longitudinal arch.

Callusing on the medial aspect of the big toe is typically a direct result of footwear rubbing directly on that area of the toe. However, a medial big toe callus can also arise from increased pressure when walking or running on a big toe that has a bunion. 

In a healthy gait, bodyweight forces are transferred through the tip of the splayed big toe. With a bunion, those forces tend to travel through the medial aspect of the big toe, often accompanied by an outwardly rotated foot and leg posture.

As a bunion progresses to more advanced stages, ligaments can start to stretch and loosen causing further instability. With advanced bunions, not only does the big toe point laterally but the 1st metatarsal gets pushed medially, creating a more significant bunion angle. 

The term for this is hallux abducto valgus (HAV), with the abducto part referring to the 1st metatarsal drifting medially. Any joint that is continuously used in misalignment will eventually start to wear down cartilage within the joint and bring forth an inflammatory response. 

Bony growths (e.g. osteophytes/spurs) can begin to form in response to bones rubbing together and the ensuing inflammation. At this point of the progression of a bunion, pain and instability are typically part of the big picture.

Big toe alignment is especially important due to its critical role in influencing the stability and function of the foot’s main arches. The big toe (along with the heel bone) is an endpoint of the medial longitudinal arch. Like all arches, if the endpoint becomes misaligned, the arch weakens and tends to collapse. 

When the big toe isn’t in alignment with the rest of the foot bones that make up the arch, the integrity of the arch becomes compromised and the whole foot suffers as a result. An aligned (splayed) big toe helps maintain a healthy foot posture by preventing the foot from falling too deep into pronation. 

Arch supports and orthotics can help to temporarily bypass this “overpronation” instability born from a misaligned big toe, but they don’t really solve the problem. A foot that doesn’t have the alignment or strength to control pronation can lead to medial ankle pain, knee pain, hip pain, and back pain. Below is a video from Dr. Ray McClanahan demonstrating the relationship between the big toe and the medial longitudinal arch.

A bunion can become much more than a big toe problem, so it’s important to monitor bunion signs and symptoms. Of course, bunion prevention is best, so check your footwear and make sure there’s enough space in the toe box for splayed toes. 

The shape of the shoe should allow the big toe to remain aligned with the 1st metatarsal. Correct Toes toe spacers are a fantastic tool to help gently reposition the toes into a more optimal alignment—plus you can be active in them! Exercising the feet while the toes are in a more ideal alignment is the safest way to exercise, and the best way to train the toes to stay in alignment.

If you think you might be developing a bunion, now is the time to start working towards reversing it. As always, first, check in with your personal doctor for an assessment and to see what treatment strategies they have to offer. If you’re told to “come back for surgery when it gets worse,” consider looking for help elsewhere. Northwest Foot & Ankle, the Correct Toes-adjacent natural foot health clinic founded by Dr. Ray McClanahan offers both in-office medical visits in Portland, OR, as well as remote video consultations for anyone anywhere else in the world.

Bunion FAQs

What causes bunions to develop? 

Most bunions are caused by modern shoes that are tight, narrow, and designed for fashion not comfort. If you wear such footwear, you might experience discomfort, pressure, and a gradual development of unnatural foot shape.

Can bunions be prevented? 

The short answer is yes! Preventing the progression of bunions should begin early on. You can reduce the risk by wearing shoes with a wide toe box, especially avoiding high heels and narrow shoes.  

If you notice small bunions forming, we recommend you try toe spacers to maintain proper toe alignment. This will help your feet go back to its natural form, stretch foot muscles, and relieve pain.

There are also foot-strengthening exercises that can help. We recently wrote an article about bunion prevention, which provides more details about natural remedies that you can try and explore.

What are the available treatment options for bunions? 

The treatment options for bunions vary depending on the severity of the condition. We suggest considering the non-surgical and natural approaches mentioned above to take preventive measures associated with bunions. 

In cases where bunions cause significant pain or hinder daily activities, it is advisable to consult with a healthcare professional to determine the most appropriate treatment approach for your specific case.

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.

Many athletic shoes have a rigid toe spring and narrow toe box that tapers to a point in the middle of the foot. This obviously lifts and pinches the toes together—a subfunctional foot/toe position that is unstable—which increases the risk of injury and hinders performance potential. An aligned big toe is absolutely critical to maintaining a healthy and functional arch—so it makes no sense to push the big toe towards the foot’s midline and lift it above the ground surface. Many more athletic shoes will pair this type of negligent toe box with an elevated heel that further compromises the positioning of the foot and ankle. As one can imagine, this combination creates an even more chaotic and dysfunctional environment for the foot to try to navigate. A foot forced to operate from this positioning really can’t help but overpronate. Dr. Ray McClanahan demonstrates this vividly in his Pronation vs. Overpronation YouTube video. The athletic shoe attempted solution for this self-created instability and overpronation is a built-up “arch support” on a stiff sole that forcefully resists overpronation. It’s a clever band-aid for a self-created problem, but these “arch supports” also prevent natural and normal pronation from happening—a literal bump in the road to a healthy gait.

It’s true that tight footwear is necessary for certain sports, which is why it’s so important to take extra care of the feet when they don’t have to be in that type of restrictive footwear. Within tight, stiff, supportive footwear, the many small bones and joints of the foot become essentially immobilized into a compromised foot posture, and the foot muscles’ ability to appropriately engage, strengthen, and adapt to the varying ground surfaces greatly diminishes. The small intrinsic foot muscles are critical for balance, explosiveness, and injury prevention, but are often underdeveloped due to chronic over-use of ill-fitting footwear and naivety surrounding natural foot health. An obvious strategy to address foot weakness is more external structure and support using taping, compression, braces, etc. There is certainly a time and place for extra support when injured and when performing—but typically while training and in everyday life, the feet should be generally uninhibited and left to support and move you as they were designed to do.

Dangle one foot in the air and observe the shape and width of that foot while non-weight-bearing. Now stand one-legged on that same foot alone. There should be a noticeable difference, especially in width. In many tight athletic shoes, this spreading of the foot while weight-bearing is significantly restricted. Over time, this can create a lot of pressure, tension, and friction within the foot.

The toes, feet, and ankles have become (in my humble opinion) untrusted and untrained in athletics NOT because feet are incapable of performing to our desire, but because they are continually asked to perform from a less-than-optimal (and often harmful) position. This blindspot becomes predictably exacerbated when we also chronically train, and live our day-to-day lives, with our feet in similar positioning. Like water in a vessel, our feet eventually conform to the shape of our shoes over time. Time moves faster for athletic feet and feet that take more steps, but the endpoint is the same—feet shaped like shoes. The less often we’re barefoot, the further we stray from true natural foot health.

It was Leonardo Da Vinci who famously said, “the foot is a masterpiece of engineering and a work of art.” And it is truly remarkable to see the structural similarities between the skeletal arches of the foot and the strongest manmade arches. 

Ideally, foot-shaped, zero-drop, barefoot-mimicking footwear would be accessible for all types of sporting occasions. The reality is, we’re not there yet—so for now, we must meet people where they’re at. If you’re an athlete that can’t currently escape your performance footwear, there’s still plenty of ways to incorporate natural foot health into your training, recovery, and everyday lifestyle. 

1. BAREFOOT TRAINING

Training in conventional athletic footwear that has arch support, extra stabilization features, and lots of cushioning significantly limits the foot’s ability to function and efficiently absorb impact. Instead (often unknowingly), these impact forces are transmitted up the skeletal system to the shins, knees, hips, and lower back. When training barefoot, you quickly realize that without lots of cushioning or super-soft ground, the heel bone is NOT great at absorbing impact. It takes time and patience to adjust as responsibility for stability and shock absorption shifts to the muscles of the feet and ankles. This will feel unfamiliar and often overwhelming to feet that have spent significant time inside unhealthy footwear. However, the truth is: the foot is capable of all this and more—so long as it’s positioned as nature intended with strong and limber muscles.

Our feet were designed to move and support us for a lifetime, and they will if we take care of them. And by “take care of them” I mean appropriately loading and challenging the feet and ankles and using them to their fullest extent. NOT forever immobilizing, excessively supporting, and pampering the feet always. Barefoot training engages and strengthens smaller intrinsic foot musculature that gets neglected within stiff and ill-fitting conventional athletic shoes.

Beyond any potential athletic performance enhancement that comes with having stronger and better-controlled muscles, the intrinsics are also important for balance by helping your feet to adjust and adapt to the surfaces you’re standing on. And perhaps just as importantly, strong intrinsic foot muscles also help protect the foot from common nagging injuries like plantar fasciitis/fasciosis, stress fractures, shin splints, bunions, bunionettes, hammertoes, and many more. 

Another benefit of training barefoot is sensory feedback and proprioception—your awareness of your body in space. A lifetime of wearing cushioned rubber under the soles of our feet has left most feet predictably hypersensitive to even the most mildly textured surfaces. If feet are always wrapped in a fluffy cushion and aren’t regularly exposed to varying hardness and textures—carpet, wood, grass, cement, rocks, sand, etc.—they will inevitably become hypersensitive to touch. For an analogy: imagine wearing earplugs all day every day since the age of two. Then as an adult, the first time those earplugs are removed, everything in the world would seem screamingly loud. The sense of hearing had been excessively sheltered and deprived for so long and is now starved for stimulation to the point that faint whispers register as fire alarms. Similarly, attempting barefoot training without properly transitioning from years (possibly a lifetime) of cushioned, supportive shoes is like being in the front row at a rock concert after wearing earplugs your entire life: too much, too soon. Yet regulating this sensory feedback system is paramount for your nervous system health. With as many as 200,000 nerve endings per sole, the bottoms of the feet absolutely crave attention, texture, and mobility. Establishing good nerve health and sensory feedback from the feet is not only beneficial for an athlete today, but is also important for foot health and balance longevity.

Training barefoot is truly the best way to engage, strengthen, and ultimately protect your feet. However, if you’ve only ever trained with shoes on and/or you’re not barefoot very often, then your feet might not be quite ready to train barefoot just yet. If this is the case, you can start “transitioning” simply by being barefoot at home more often and getting a pair of zero-drop, wide-toe box shoes to allow your feet some time to adjust in. See our blog post on transitioning here. Also check out our YouTube page for mobilizing, stretching, and strengthening exercises that can help smooth your transition.

CORRECT TOES

Individual professional athletes and strength & conditioning staffs from the top professional sports leagues worldwide use Correct Toes to help reverse the damaging effects of narrow, tapered toe boxes. This medical-grade silicone toe spacer helps to position the toes into optimal anatomical alignment and can be customized to fit your unique foot. Correct Toes were designed to be worn while active and exercising so that foot muscles can engage and strengthen into a healthy alignment. Correct Toes can be worn barefoot or within shoes that feature a toe box wide enough to comfortably fit them. We have a list of Correct Toes Approved footwear here. For further reading about some of the specific benefits of Correct Toes for athletes, check out our Correct Toes for Basketball Players post from 2 years ago.

2. CROSS-TRAINING WITH NATURAL FOOTWEAR

Even if you have to wear cleats or specialty footwear during athletic performance, typically other training environments will allow for more flexibility when it comes to footwear. Fortunately, there are several good footwear options to choose from when it comes to zero-drop, wide-toe box running and hiking shoes (some companies are starting to make cross-trainer gym shoes too). Altra, Topo Athletic, Vivobarefoot, Xero, Joe Nimble, and Bearfoot are all examples of shoe companies that make varying styles of athletic shoes shaped like healthy feet that will mostly accommodate Correct Toes. If you are able to wear general athletic and running shoes during certain parts of training, consider using shoes from these brands (Altra typically has the most cushion so they are recommended for people who are used to more supportive and cushioned shoes). The overarching benefit of training in a zero-drop, wide toe shoe is that it gives the foot an opportunity to support itself naturally and operate from more ideal positioning, while still offering significant protection (and sometimes cushion). Similar to training barefoot, these barefoot-style style shoes encourage natural mobility and intrinsic muscle strengthening to help better prepare your foot for when it has to be back inside of a conventional athletic shoe. For Basketball-specific footwear, check out our post from 2 years ago, Basketball and Natural Footwear Options.

3. MODIFYING FOOTWEAR TO FIT YOUR FEET

Since there aren’t any foot-shaped cleats (or basketball shoes, etc.) yet, shoe modifications are a simple strategy to help you change your footwear to fit your feet better. The most egregious problem with athletic shoes is usually a narrow, tapered toe box. The first and easiest way to tackle this is by simply removing the removable insole from the shoe if the shoe has one. Another strategy is to re-lace the shoe so the lacing starts 1-2 eyelets back from the toe box. This gives the upper more ability to expand around the toes. Additionally, a wooden shoe stretcher or ball-and-ring stretcher can help to expand the toe box upper material; but if the upper won’t stretch, small incisions can be made in the toe box upper to allow the toes a little more room. Of course, it also helps if you have a wider shoe model to start with in the first place.

Another potential solution found while researching was a company called Custom Cleats that transplants cleats onto sneakers and other types of shoes. It’s unclear how this process would work on a minimalist shoe, but it might be a viable solution for foot-shaped shoes that have a thicker stack height. A similar clever solution for golfers comes from the company Golfkicks, which sells individual golf spikes that can be screwed into the bottom of sneakers with thick enough stack heights (1/3 inch).

RECOVERY

Correct Toes toe spacer is a fantastic tool for training, encouraging the development of natural stability and strength. But Correct Toes is also a great recovery tool too! Anyone who’s been a part of grueling sporting matches with their toes crammed into tight athletic shoes knows what a relief it is to take those shoes off post-game and let your feet breathe and toes splay out wide. Correct Toes can help to make sure that a healthy splay—anatomically appropriate for your foot—is maintained during the recovery period. Having the toes properly aligned not only solidifies inherent foot stability, but also positions the nerves, vasculature, and other soft tissues into their optimal alignment. For context, when the big toe gets pushed over as seen within a narrow toe box, blood flow to the foot can decrease by 20% (Jacobs, et al. 2019)!! Conversely, when the toes are aligned with the foot bones, the foot vasculature becomes optimally positioned for robust blood circulation and healing response. The feet are furthest from the heart and injuries commonly happen to poorly vascularized structures, so maintaining optimal blood flow is critical for healing chronic foot injuries. These circulatory benefits, in conjunction with the natural stability that comes from the foot posture facilitated by Correct Toes, go a long way towards keeping minor injuries from lingering and preventing injuries altogether.

If you’re someone who is often active in shoes that aren’t flat and foot-shaped, it’s only a matter of time before your feet start to become shaped by the shoes they reside in. And until more foot-healthy specialty athletic footwear exists, harm reduction is our best strategy at improving this type of athlete’s foot health. I hope this article helps to increase awareness of some of the problems in athletic footwear and the potential consquences, as well as provide some useful strategies for navigating natural foot health in a world full of unnatural footwear.

Addendum: There is a new, rising startup shoe company called CODE Footwear that makes sneakers and cleats custom-built for your specific feet based on a volumetric 3D foot scan. They are currently taking pre-orders for both footwear options with an anticipated launch date of Spring 2022. Cleats are estimated retail price of $695 and the sneakers are $595, and I don’t think that covers the cost of a foot scan. This could be the future of footwear moving forward, folks!

*** This post is for educational purposes only and is not medical advice. Please consult with your holistically-minded health provider before initiating any treatment strategies.

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.

Shin splints, sometimes called medial tibial stress syndrome (MTSS) or tibial periostitis/fasciitis, are one of the most common lower leg injuries seen in athletics. Shin splint pain typically radiates along the medial and posterior edges of the shin bone (tibia) and is often associated with a sudden significant increase in activity, such as initiating a new training regimen or playing a new sport. Often the pain is first felt during the beginning of the activity and then subsides as the activity progresses, only to return hours to days later with a vengeance. Shin splints are reported most often by those who experienced chronic repetitive stresses to the lower legs, such as runners, dancers, soccer players, military, etc. Similarly to many pains of the foot and lower leg, the cause of shin splint pain is multifaceted but mostly the result of biomechanical issues and muscle imbalances that stem from a general lack of use. Additionally, most shoes have become so supportive and protective to the point that our feet have become weakened and hyper-sensitive as a result. Inflammation to the periosteum—a vascularized, innervated tissue that covers bones and joints—arises from friction, rotation and torque along this membrane during activity. Shin splints, however, are still more a symptom of an underlying musculoskeletal or movement problem, rather than a true medical condition in and of itself.

RECENT RESEARCH

A recent study published by Mattock, et al. in the Journal of Foot and Ankle Research just last month (July 2021) observed that people experiencing shin splints were found to have both structural and functional changes to several muscles of the lower leg when compared to their asymptomatic counterparts. According to this study, those with shin splint pains were found to have significantly smaller flexor hallucis longus and smaller soleus muscles, but a larger lateral gastrocnemius. Additionally, symptomatic individuals also displayed statistically significant deficits in strength (measured by dynamometer) of the flexor hallucis longus, soleus, tibialis anterior and peroneal muscles, as well as a reduced ankle plantar flexor endurance capacity (a single leg heel raise protocol with participants attempting to perform as many single leg heel raises as possible). Of course, this study only highlights correlation, not causation; but it is another important piece to the puzzle.

WHAT CAUSES SHIN SPLINTS?

Generally speaking, there are two simplified ways in which muscles become deconditioned from lack of use. If a muscle is chronically held in a contracted position, that muscle will likely become short, tight and knotty. If a muscle is chronically held in a lengthened position, that muscle becomes elongated, lax and ropey. In both cases the muscles become weakened and are unable to provide the natural support and flexibility necessary to function at a high level, pain free.

We’re already aware of how fashion footwear can affect the shape and strength of certain muscles and tendons. Injurious footwear featuring a rigid toe spring, tapered toe box, and an elevated heel will hold the toes and forefoot in an extended elevated position. This position both overstretches and inhibits the flexor muscles on the bottom of the foot from functioning properly, causing the flexor hallucis longus and flexor digitorum longus muscles (which attach at the mid-tibia and -fibula down to the tips of the toes, running deep to the gastrocnemius and soleus) to become long and weak—a finding similarly reported in the research done by Mattock, et al.

Chronically wearing and exercising in footwear featuring a heel elevation also has the unfavorable consequence of shortening and stiffening the calf and Achilles tendon. The gastrocnemius and soleus muscles together form the bulk of the calf muscle, combining (also with the plantaris muscle) to attach on the calcaneus (heel bone) forming the Achilles tendon. The gastrocnemius is the most superficial calf muscle and crosses both the ankle and knee joints. It’s a powerful muscle that does a fine job of grossly plantarflexing the ankle and flexing the knee, as well as encompassing the rest of the posterior leg compartment under its sheath-like hood—but it is the soleus that more so exudes the finer motor control portion of plantarflexing the ankle; including stabilizing the ankle and appropriately receiving the ground when in motion, especially when forefoot striking. The soleus is also more prominently used to stabilize the lower leg when standing. However, footwear with built-in support “technologies” like artificial arch support, a wide-flaring outsole and rigid heel counter can over-stabilize the ankle to the point that other important stabilizing muscles like the soleus become neglected and ultimately weaken. When the soleus weakens, we commonly see the lower leg compensate by relying more on the gastrocnemius. This scenario is also reflected in the research by Mattock, et al., where we see a significant decrease in both size and strength of the soleus paired with an increase in gastrocnemius size.

“The human foot is a masterpiece of engineering and work of art.” – Leonardo Da Vinci

ARCHES, CUSHIONING & IMPACT FORCES

The three main arches of the foot are magnificently designed, take it from Da Vinci. These strong yet mobile arches can bear immense weight and withstand substantial impact forces when they’re appropriately utilized. Arch mobility and strength also help us balance by allowing the feet to make a plethora of tiny adjustments at any moment to match any terrain.

Footwear which artificially props up and “supports” the medial longitudinal arch actually prevents the arch from doing its job: receiving the ground as the foot pronates and transferring that energy into the next step. Instead, overly supportive footwear with thick cushioned outsoles mask the foot’s initial impact forces—bypassing the foot’s arches—but still allowing those forces to travel upstream into the shins, eventually to the knees, hips and low back. Additionally, many cushioned running shoes with elevated heels make heel striking comfortable by slowing the rate of loading, but this does not eliminate the impact forces. On the contrary, studies show that heel striking while running produces forces up to 3 times your bodyweight (7 times more impact force than experienced by forefoot strikers). For most people this can mean anywhere from 450-650 lbs. of force every single step! These impacts add up, since you strike the ground almost 1000 times per mile! When your foot and ankle are unable to adequately absorb and dissipate these forces they travel next through the tibia and fibula. Daniel Leiberman of Harvard Barefoot Running describes this heel-striking transfer of energy with an analogy of dropping a metal rod vertically on its end—the rod comes to a sudden, loud and jarring stop. It may seem counterintuitive to suggest less cushioning when considering forces of this magnitude; however, what happens with less cushioning is humans tend to naturally shift their running form towards biomechanically protecting their heel with more of a forefoot and/or midfoot strike. This running style is also commonly seen in cultures that are habitually unshod or typically wear only thin sandals as footwear, which highlights, perhaps, an ancient natural wisdom.

TREATMENT APPROACHES

While shin splints are more often experienced as a nagging pain, if left untreated they can progress towards debilitating pains and even stress fractures of the tibia. The first—and most obvious—approach to shin splints is to simply rest. Time heals and most cases of shin splint pain will resolve within hours to days after the triggering event. Ice and anti-inflammatories can help with immediate pain, but can carry a steep cost by reducing and delaying any healing response—which is what the inflammatory process actually is. Certain medical websites and running advice resources will suggest targeting the inflammatory response instead of targeting what is triggering the inflammatory response (tight muscles pulling on the periosteum and weak muscles unable to support the bone and joints), which is a very short-sighted way to approach chronic pain problems. We suggest briefly using ice for short bouts of acute inflammation following activity (only when needed), and utilizing heat to stimulate blood flow and a healing response during asymptomatic periods for a more nuanced long-term approach to chronic recurring shin splint pain.

Conventional podiatrists might also suggest stiff orthotics or other supportive cushioned inserts to help remedy shin splints. These devices might help with pain and comfort in the immediate short-term, but will ultimately weaken the muscles of the foot and lower leg, eventually leading to worsening symptoms.

The natural approach to rehabbing shin splints includes an active recovery and should be approached slowly, thoughtfully, and progressively. Once pain has subsided, stay active by cross-training and doing low-impact activities like cycling and swimming, while also regularly doing exercises (examples below) that target muscles in the foot and lower leg. These exercises are designed to mobilize and strengthen the muscles associated with shin splint pain:

1. 1. Lengthen the top of the foot and front of the leg → unlocks/releases extensor dominance and allows flexors begin shortening and strengthening.
   1. –Toe extensor stretch.
   2. – Advanced: kneeling tibialis anterior stretch.
   3. – Also try rolling bottom of foot on lacrosse ball and/or using a metatarsal pad
2. 2. Shorten and strengthen flexor muscles in bottom of foot and lower leg.
   1. – Toe yoga – for toe mobilization and dexterity.
   2. – Toe presses – strengthens flexors.
   3. – Toe curls – strengthens flexors.
   4. – Short foot – strengthens arch muscles.
3. 3. Lengthen and strengthen soleus muscles. The gastrocnemius crosses both the ankle and the knee joints, while the soleus only crosses the ankle joint. So to engage more of the soleus and less of the gastrocnemius, soleus exercises are performed with the knees bent.
   1. a. Soleus stretch. Simply only wearing zero-drop shoes or barefoot will help reset your calf muscle length, but stretching can help accelerate the process.
   2. b. Soleus strengthening.
      1. – Bent knee calf raises.
      2. – Seated weighted heel raises.
      3. – Tip toe walk.
4. 4. Strengthen peroneal muscles.
   1. – Calf raises that supinate/invert the ankle and roll onto outside of foot
5. 5. Barefoot walking is a total foot workout that engages all of the muscles of the lower limb; however, it’s important to start low and go slow. Weak muscles and hyper-sensitive feet can overwhelm inexperienced barefoot walkers shockingly quickly.
   1. – Advanced: barefoot running.

Walking Barefoot While Carrying Running Shoes

Once running, hiking, and moving again, it is generally wise to increase mileage and intensity by about 10% per week. If shin pain returns, take a couple days to rest, then mobilize and strengthen again before continuing on your path. If shin pain persists, contact a medical professional. The information contained in the post is for educational purposes only. If you are experiencing shin splints or similar pain, please seek medical advice before initiating any treatment regimens.

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

Schedule a virtual remote consultation with Dr. Andrew Wojciechowksi, ND.

Schedule an in-person appointment with Dr. Andrew Wojciechowski, ND at Northwest Foot & Ankle in Portland, OR.