What the shape of your toes says about your health… and why unlikely changes may be a sign of diabetes, infection or nerve damage
Millions of people look down and notice their toes look different than they once did.
In fact, about one in three Americans will develop some change in the look and shape of their toes within their lifetime.
But fewer are aware that the shape of their toes is not just cosmetic – it may provide vital clues about their overall health.
Toe deformities such as hallux abducto valgus – better known as bunions – and clawed toes can be directly related to footwear choice over many years, resulting in severe pain, especially when walking or putting on different shoes.
Rubbing of materials in narrow and shallow-fitting shoes can also worsen symptoms over time. The greater the pressure on joints in the toes over time, the greater the likelihood of the toes conforming to the shape of the environment around them.
But aside from footwear choices and traumatic injuries, toe shape can also be a sign of inflammatory conditions such as psoriatic arthritis and peripheral neuropathy.
Subtle curling, swelling or calluses can also be early signs of vascular damage and long-term conditions such as diabetes.
While it’s easy to overlook the toes, people experiencing shape changes who do not receive prompt treatment can go on to develop complications such as blisters, non-healing ulcers and even amputation, in severe cases.
Millions of Americans experience changes in the shape of their toes, but fewer are aware that these may signal serious health conditions
For this reason, it’s crucial to consult a podiatrist with any unusual changes, especially if they persist after changing footwear and rest.
The appearance of a single ‘sausage-like toe,’ for example, can be confusing to work out for affected individuals, particularly if they experience sudden inflammation and pain.
In the first instance, it is essential to contact your doctor for assessment, as this can help detect an underlying inflammatory condition such as dactylitis – swelling of a single toe or finger that’s also known as ‘sausage digit’ – gout or presence of bacterial infection.
Jonathan Brocklehurst (pictured) is a podiatrist who has seen hundreds of patients with changes to their toe shape
According to recent research in Diabetes Care Journal, individuals with nerve damage and muscle wasting conditions may be more likely to present with toe deformities, which can increase the risk of abnormal pressure distribution and lead to wounds and ulcers.
Clubbed or enlarged toes may also be a red flag signal of oxygen deprivation to that area, which can occur with heart disease.
Recognizing changes in the shape of the toes early alongside appropriate footwear choices can be the difference between faster surgical intervention and a higher risk of falls, wounds and infection.
The top five symptoms to be aware of are a loss of sensation in the toes, tingling or numbness, prominent toe joints, signs of infection – heat, redness and swelling) – and sharp pains.
Some people may be more prone to changes in the shape of their toes based on their genetics, lifestyle and footwear choice.
I remember a particular patient, a man in his 80s, who had been playing golf for 20 years since his retirement and complained about how his little toe was starting to overlap the fourth toe, causing rubbing and a painful corn on the inside of the little toe.
When I made a silicone toe prop to separate the web space between the two toes, he mentioned experiencing less pain due to the offloading of pressure away from the rubbing forces between prominent toe joints. This also made him more comfortable while he golfed.
Treatment for toe deformities can include removable props and sleeves, as well as surgical interventions
Crucially, he felt less pain for a longer period of time. The most significant impact was actually made by the patient himself when purchasing a pair of wider fit shoes for golf, which reduced the rubbing on the outside of his little toes and reduced pressure onto the fourth toe.
Treatment for toe deformities such as hammer or clawed toe can include conservative management using silicone toe props and foam sleeves to protect the toe and relieve pressure.
In severe cases where pain experienced may affect the ability of an individual to conduct day to day activities, a doctor may consider surgical treatment to ‘correct’ the affected joint in the toe.
In cases of severe toe deformity, bespoke footwear and walking aids may benefit the patient in the long-term to maintain balance and reduce pressure on affected toes.
Sadly, in some cases, this realization comes too late, resulting in blisters turning into wounds which ulcerate, become infected and require amputation due to lack of blood flow to the feet due to the effects of diabetes.
Therefore, seeking advice from a podiatrist is crucial even if there are initial ‘gut feelings’ or general concerns about a possible change in shape of the toes.
Don’t ignore it. The earlier you raise concerns, the more likely a better outcome for treating changes in the toes to improve quality of life.
Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist based in the UK.
