Functional toe taping
If joint pain is the main problem
- Simple analgesia or non-steroidal anti-inflammatory medication may be enough to manage pain in some patients.
- Functional toe taping aims to limit dorsiflexion and is relatively unobtrusive in a shoe, even for runners. Patients generally use it for 4-6 weeks and can often discontinue it then. A few resume taping if the pain flares up again. We normally recommend taping as first line treatment before injecting the joint
- An injection of steroid and local anaesthetic into the joint was successful in two reported studies (Trepman and Yeo (1995) and Mizel and Michelson (1997)), both of whom also used a stiff insole and rocker to limit dorsiflexion. Not all our patients are keen on shoe modifications and we tend simply to inject.
If pain under the joint is a significant problem
Metatarsal dome insole
- Analgesics, taping and injection can help.
- A metatarsal dome insole can also be useful in improving mobility.
If pressure from a stiff hammertoe or dislocated MTP joint is the main problem
- Increasing the room in the toe box of the shoe can reduce rubbing.
- However, many of these patients will ultimately opt for surgical correction.
How successful is non-surgical management?
Mann's original paper recorded successful non-surgical treatment in only 1/7 patients, and Coughlin (1993) succeeded with taping in only 2/9 athletes. However, Trepman and Yeo (1995) managed 13 patients with a steroid injection, rigid insole and rocker, with only one failure; Mizel and Michelson (1997) treated 13 patients with the same regime and two failures; and Peck et al (2006) used a variety of non-surgical methods in 164 patients, of whom 55 (33%) required surgery.