Toe Spacers Play a Role in Correcting Foot Problems

Toe Spacers Play a Role in Correcting Foot Problems
Toe spacers can prevent toes from drifting out of order and offer recovery after wearing constricting shoes. Photo courtesy of NABOSO
Amy Denney
12/2/2022
Updated:
3/22/2023

Toe spacers are a useful tool for anyone whose feet spend a great deal of time scrunched inside shoes.

While they aren’t a miracle cure for major foot problems, toe spacers can help stretch out and realign toes that are beginning an inward compression. They can prevent toes from drifting out of order and offer recovery after wearing constricting shoes. And they can hold toes in the correct position for patients doing rehabilitation to prevent or recover after surgery.

Toes that are straight, spread, and flat are normal for foot physiology but those traits often vanish in feet constantly in shoes that are narrow, rigid, overly structured, or have an incline. Toes may not seem like that big of a deal, but they’re connected to the body’s muscular, nervous, and circulatory systems. They constantly read and respond to sensory information that is foundational to the body’s operation.

“Separation of toes can help if used in the right way,” Dr. Paul Thompson said. “A big part of my practice is exercises based around stability and strength.”

To speed up healing, he often recommends toe spacers for patients to hold their feet and toes in the correct position while doing prescribed exercises. Toe spacers are usually made of silicon or gel and slide between the toes, stretching out not just muscles in the toes but the connective tissue holding together the entire foot.

Some podiatrists are recognizing the value of approaching toe deficiencies in a more holistic, gentler way using exercises and tools in place of the more traditional, invasive model of orthotic inserts and surgeries.

“The industry has gone down a path that’s more monetary based rather than looking at the whole person and how you can get them better,” Thompson said.

But he’s quick to point out that while some patients will still need surgery, a functional approach can make operations a last resort. Plus, learning foot exercises helps people recover from surgery and prevent further problems.

Who Needs Toe Spacers?

Podiatrist Dr. Emily Spilchal recommends toe spacers to about 95 percent of her patients.

Because toe spacers are good for preventing foot problems, just about anyone could experience benefits from using them. Both Spilchal and Thompson regard foot education as an important part of their responsibilities.

Here are seven situations in which Spilchal says toe spacers can help:

1. They naturally align the toes, which is helpful for bunions. Bunions are bony lumps on the outside of a big toe joint caused by compression of the toes. When the big toe starts to gravitate toward and sometimes overlap the second toe, the bottom joint juts outward to compensate for the pressure. Bunions can be caused by narrow shoes, arthritis, and foot deformities.
2. They straighten and lengthen toes, which helps correct and prevent hammertoes. This is a condition where a toe bends downward and the middle joint sticks up, creating deformities in tendons and joints. The most common cause of hammertoes is wearing shoes that are too tight.

(Spilchal doesn’t recommend a popular exercise of gripping and scrunching a towel with the toes. Even though it seems like it would strengthen smaller muscles, it actually trains the toes to curl under rather than to straighten into the preferred position that’s necessary for gait.)

3. They spread and splay the toes, relieving pressure on nerves. This is especially helpful for neuromas, nerve “tumors” that are caused by trauma from high-arched feet, flat feet, and high heels that squeeze and compress nerves.
4. They allow toes and feet to reset, “breathe,” and open up. Recovery for feet that have been in shoes all day is something everyone can do to prevent deformities. Spilchal recommends her patients wear toe spacers while cooking dinner or eating, because it’s a simple, passive way to create a habit.

“I try to create easy foot recovery techniques for patients that they can actually implement successfully,” she said.

5. They stretch out and release pressure and tightness caused by plantar fasciitis and arch pain. The plantar fascia is connective tissue that runs from the heel and inserts into the base of the toes, supporting the arch and playing a mechanical role in walking. Toe spacers can improve circulation and restore function to this vital, sensitive tissue. Plantar fasciitis, an inflammation of the tissue, is common in people with flat feet, high arches, and those who put a lot of stress on their feet. Insufficient foot strength and excessive foot stress are risk factors for inflammation.

“You always have to make sure you’re balancing stress with recovery,” Spilchal said.

6. They create stronger toe flexion, which improves balance for anyone with equilibrium problems. Toe flexion, the ability of toes to bend at the joints, improves balance, leg stability, athleticism, and peak vertical jump. Besides athletes, those with neuropathy or recovering from a stroke may also need to improve toe flexion.

“Balance exercises are really good for your feet because it requires them to contract and engage,” Spilchal said. “I want them to be done barefoot.”

7. They optimize the lever mechanism of the foot by lengthening toes. Longer toes create more torque and power.
“I want athletes, as an example, to have long, flat, straight digits so they can really catapult and push off of the foot,” Spilchal said. “Strong toes do not grip like the hand does. The foot is very different from the hand. People will make analogies but they are actually very different in mechanics.”

Exercise Is Everything

Rehabilitation, though not easy, has more sticking power. When Thompson explains the benefits, he said most patients actually prefer it to surgery.

“You have more control over your treatment rather than putting all your treatment in my hands,” he said. “I find if you take accountability and you understand what we’re trying to achieve, you get a better result, and it will last you longer.”

He recently saw a patient who previously had surgery to correct a bunion. Though his toes looked perfectly straight because of four screws, his foot was unable to move correctly and had functional problems.

“It might fix that particular issue, but if you aren’t looking at function ... it can lead to a lot of other problems as well,” Thompson said.

Exercises are designed uniquely for patients, he said, depending on the diagnosis. But there are three basic ones anyone can do:
  • Vertical “toe yoga”: Lift the big toe up while the other toes stay down and then lift the smaller toes while the big toe stays down. This engages toe and arch muscles.
  • Horizontal “toe yoga”: Move the big toe out away from the other four toes.
  • Short foot: Put equal weight on a triangle of points on the heel, the big toe pad and pinky toe pad. Then create an arch by gently pulling (but not curling) the toes toward the heel.
“Sometimes those three can be just enough to wake things up for people, giving them feedback and feeling when they’re using their feet,” Thompson said.

Spilchal said basic, easy exercises work best, done with bare feet.

She also said people should walk barefoot at least 30 minutes daily.

“There’s more and more validation, more and more barefoot training research,” Spilchal said. “Research has shown minimal shoes actually strengthen the foot muscles.”

An Individual Approach

In addition to unlimited styles of shoes that influence foot development and functionality, how we spend our time, our anatomy, and the surfaces we walk and run on can impact foot health.

Movement done on hard tile and concrete is less forgiving than walking on surfaces that are more natural, like wood and dirt.

Also, feet can become passive over time and degrade structures like tendons, nerves, and bones. The degree of insult can also influence the approach podiatrists take with rehabilitation. Even though barefoot therapy is critical, it can be too abrupt for someone with severe bunions and hammertoes. Better footwear and toe spacers may need to be introduced gradually.

Spilchal said variability of surfaces, in addition to foot posture, should all be taken into account in recovery.

“It’s an overly rigid foot that cannot withstand the pressure,” she said. “An otherwise neutral or sufficient foot should be able to meet the demands of movement without too much structure or support.”

Thompson, whose podiatry practice has evolved to offer workshops and preventative care products, changed his own views when the orthodox approach wasn’t working for his own feet.

“I couldn’t figure out why I couldn’t get my own feet better,” he said. “I tried lots of different pairs of orthotics, different shoes, and materials of orthotics.”

The relief was temporary until Thompson began to study the biomechanical issues of feet that weren’t taught in medical school. He realized he needed to stop wearing traditional shoes, even athletic sneakers because the heel is slightly raised and the toe box often curls up.

“They have features that are detrimental to how the foot functions,” he said. “That changes everything, how your muscles in your glute work. It changes the position of your calves, your ankles, and puts more pressure on your knees.”

Now you can find him hiking with his young children barefoot—unless the location might be dangerous. When they wear shoes, they are flat, flexible, and have a wide toe box.

Amy Denney is a health reporter for The Epoch Times. Amy has a master’s degree in public affairs reporting from the University of Illinois Springfield and has won several awards for investigative and health reporting. She covers the microbiome, new treatments, and integrative wellness.
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