Massage & Bodywork

May/June 2012

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technique BODYREADING THE MERIDIANS | @WORK | ESSENTIAL SKILLS | MYOFASCIAL TECHNIQUES Working with Hammertoes: the Foot By Til Luchau 1 3 4 Hammertoes range from moderate (Image 1) to severe (Image 2). Remedies include spacers and splints (Images 3 and 4), exercises, and surgery (Image 5). Images 1 and 2 courtesy Primal Pictures; Image 3 courtesy CorrectToes. com; Image 4 courtesy; Image 5 courtesy James C. Mutter, Kamran Jamshidinia, MD. All used by permission. 5 2 My grandfather loved to hunt quail, walking the fields and thickets of his native western Oklahoma prairie. At some point toward the end of his life, he switched from walking to driving, hanging his shotgun out the window of his old sedan, slowly cruising the back roads, still looking for quail. "It's my hammertoes," he'd say. "Just can't walk around like I used to." A hammertoe is bent downward (Images 1 and 2), resulting in painful pressure on the end of the toe or its upper side where it rubs or hits the shoe. Common causes and risk factors include: • Wearing narrow or tight-fitting shoes. • Imbalanced muscle strength, tonus, or flexibility in the foot or leg. • Direct trauma or injury to the structures involved. • Genetic influences such as Morton's toe, in which the second toe is longer than the great toe, making it more likely to hit the end of the shoe. • Neuromuscular diseases (e.g., cerebral palsy, Charcot-Marie- Tooth disease, multiple sclerosis), inflammatory diseases (e.g., psoriasis, rheumatoid arthritis), and the nerve damage sometimes accompanying diabetes. The second toe is most often affected (Image 2), though hammertoe can be found in any of the toes. In a "true" hammertoe, the joint at the base of the toe (the metatarsal phalangeal joint, or MTPJ) and the next joint (the proximal interphalangeal joint, or PIPJ) are fixed in a bent position. Variations include mallet toe (when the contracture is primarily at the most distal interphalangeal joint, or DIPJ); claw toe (flexure at all three toe joints); crossover toe; and clinodactyly (congenitally curly toes). Although our discussion will focus on hammertoes, the principles and techniques here can be adapted to address these other conditions as well. Although seen in all ages, hammertoe incidence increases with maturity, eventually affecting about one in 10 people over the age of 60. Hammertoes are about five times more likely in females than males (perhaps because women tend 112 massage & bodywork may/june 2012

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