The Truth about Hammer Toes and the myths about the classically employed stretch to reduce them.
Stretching often feels good but sometimes the shortness or tightness in a tissue is not the focal point problem and it may be present as a neuro-protective phenomenon. Reducing the shortness may make an area vulnerable unless the primary problem driver is resolved concurrently or even prior.
Toes which are chronically hammered, like the ones mimicked here in the video, can shorten the capsule of the metatarsal phalangeal joint (particularly the flexor side of the joint). Hammer toes usually show a classic pairing of shortness: short extensor digitorum brevis (EDB)and flexor digitorum longus (FDL) within an environment that was likely the hammer toe precursor, that being weak extensor digitorum longus (EDL) and weak flexor digitorum brevis (FDB) as well as other functional problems locally within the foot and possibly more proximally into the ankle and lower limb/pelvis. When the capsule has been chronically shortened over time from such a scenario, the stretch shown in the video can certainly be helpful to restoring normal joint range, function and centration but this would only hold true if the capsule shortness is dorsally (top side of the joint). Hammer toes will present with plantar/flexor capsule retraction typically.
However, we need to return to the bigger question at this point, “what causes toes to curl and hammer such as suggested in this video” (besides plantar contraction of the capsule, as we just discussed) ?
Would it make sense that it was both extensors of the toes (extensor digitorum longus EDL, extensor digitorum brevis EDB) that were both short ? First of all this is not the pairing of muscle shortness in hammer toes as revealed above. And secondly, if these two (EDL, EDB) were the culprit and they were short they would cause extension of the distal part of the toe as well because they attach to the distal part of the phalanges. Again, hammering of the toes would not occur if it were the both extensors that were short. In hammer toes the EDL is weak, not short. The EDB however attaches to the proximal phalanyx of the toes and its shortness is a major culprit in hammer toe presentations. And when a person pairs the EDB shortness with long flexor shortness (flexor digitorum longus-FDL) the hammer toe results. So, technically, to reduce a hammer toe one should stretch the short extensor (EDB) and the long flexor (FDL) and the flexor part of the capsule if it is retracted. The single stretch shown in this video is not sufficient to achieve the goal we interpreted as outlined. And again, restoring all of the other functional problems along the kinetic tree that allowed for this hammering strategy to initiate in the first place.
In summary, as shown in the video, is this a bad stretch? Not necessarily, just know what you are stretching and why. In this case you are stretching the EDL and the EDB and the dorsal (top of) capsules of the digits. And if that is your goal, for whatever reason, then this stretch is fine. However, as we hope we have outlined here, the combined EDL and EDB shortness and dorsal capsule retraction are not the source of hammer toes. Again, if that were the case the toe would be straight and pointed upwards and thus not presenting as hammer toes . In our explanations here, the extensor digitorum longus is weak and lengthening an already weak muscle like the EDL would not be a great idea.
The Gait Guys. Just helping to clarify some of the specifics and errors of some of the information on the world wide web.
all material copyright 2013 The Gait Guys/The Homunculus Group. All rights reserved.