Diagnose My Symptoms Correctly – The Troubling Case of Hammer Toes

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Hammer Toes
Hammer Toes

A few years ago, I was asked to analyze a problem a friend of mine was experiencing with an uncomfortable foot deformity.  Specifically, she was experiencing a chronic and pronounced curling of her toes which produced an unsightly elevating of her middle toe joints, accompanied by frequent cramping and rubbing of her toes against her shoes, which was also producing unsightly bunions at the rubbing points—a condition described in the medical literature as ‘hammer toes’.  She had been to see her primary care provider about her problem and the doctor said the only known solution if she couldn’t live with the symptoms was surgery to cut the affected tendons and ligaments in order to straighten the toes.

Not wanting to undergo surgery that couldn’t be undone, she had tried wearing special ‘hammertoe pads’ when she removed her shoes, which were designed to separate the toes and relieve painful pressure points.  Although this device temporarily relieved some of pain when she was able to go shoeless, it wasn’t reducing the curling of the toes and the other related symptoms.  She asked if I might be able to help, and we sat down to analyze the problem with a view to finding and addressing the root cause.

The secret to solving these kinds of health problems involves carefully defining the affected people, places, and times when the problem is present, compared to the people, places, and times where the problem is not present.  The identified distinctions between the affected vs. unaffected sets of data provides clues as to the cause, which can subsequently be tested against the same facts to determine the most probable cause.  Almost always, the true cause of the problem can be pinpointed as relating to a change in the affected person’s lifestyle or exposure to some kind of environmental toxin; only in rare instances is the cause related to a genetic or congenital condition.  The good news is that once these environmental causes are identified, usually a quick and painless remedy can be applied without need for drugs, surgery, or additional medical testing.

Step 1: Describe the Problem

Our first order of business was to determine who was affected, and who wasn’t.  This was fairly clear and simple: only Pamela was experiencing this problem; close relatives and friends including her sister, brother, mother, father, co-workers, and close friends were unaffected with any similar problem.  Next, we carefully and thoroughly defined the symptoms.  Pam was experiencing an unusual and excessive bending of her toes at the second distal joint, with some calcium buildup on this second joint, and she also couldn’t raise her middle toe at all.  She was also experiencing cramping in these toes, and pain from bunions on top of the bent joints.  She was not experiencing related symptoms such as swelling, spasming, numbness, and tingling.  The severity of her symptoms seemed to be growing worse, with her second toe joint now locked in a 45 degree angle, with an escalating buildup of calcium over the angled joints.

The next step was to specify the locations, both on her body as well as the geographic locations where Pam frequented, where she was and was not experiencing her symptoms.  Interestingly, the symptoms were only being noticed on the two toes next to her big toe, on the second distal joint from the end, significantly more pronounced on her left foot.  In terms of the geographic location where she was when the symptoms presented, she indicated that they were fairly constant in Manhattan where she lived and worked, but noticeably less pronounced while recently vacationing in Costa Rica.

The last problem description category to examine related to the timing of the symptoms.  They started about a year earlier (this was in 2009), around the start of wintertime in New York.  The symptoms continued fairly regularly throughout the winter, then improved somewhat at the onset of warmer weather in the spring.  Pam also indicated that the cramps improved somewhat at the end of the day after she returned home from work, and also on weekends.  The stage in her life cycle when these symptoms manifested was at age 45, a few months after starting a new Vice President job with a large financial services company in downtown New York.   Shown below is a summary of these facts as we captured them in the problem analysis worksheet.

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Problem Description Data

Step 2: Identify the Relevant Differences and Changes

Now that the relevant problem facts and history was thoroughly described, the next step was to identify those differences pertaining to the people, places, and time affected compared to those people, places, and times that were unaffected.  The obvious major difference about Pam compared to her close relatives, friends, and co-workers was her height: she was a statuesque 6’ 1.5”.  The primary distinction pertaining to the time when the problem was first noticed was that this was shortly after she started a new executive position with the financial services company.  When I asked what was different about her affected left foot compared to much less affected right foot, she revealed that her left foot was half a shoe size larger.  Also, her two toes adjacent to her big toe were slightly longer than any other toes (including her big toe).  Finally, the primary difference about her feet while in New York vs. Costa Rica was that she wore shoes most of the day in New York whereas she went shoeless (occasionally wearing thongs) at her beachfront hotel in Costa Rica.

When a problem such as Pam’s has a sudden onset, it is usually because of a change pertaining to one or more of the distinctions identified in the analysis.  When I asked what changed about her new job, she indicated that it was more stressful, with more responsibility and frequent interfacing with the company’s CEO and other senior executives.  When I asked what changed specifically about what she was doing with her feet at this time, she indicated that she bought a new wardrobe, including new executive closed-toe shoes.  Finally, I asked what changed in that winter of 2009 compared to previous winters.  She said that she started wearing nylons under her shoes in an effort to look more professional, especially with her newly outfitted executive suits with knee-length skirts.  See the chart below for a summary of these new facts as we captured them in the problem analysis worksheet.

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Differences and Changes Data

Step 3: Evaluate Possible Causes

At this point we had enough information to put together some likely causes producing her symptoms.  Our first hypothesis related to the common issue of falling arches around middle age, which could be causing her foot to elongate, pushing her toes against the end of shoes.  Another possibility she suggested pertaining to her new job was increased stress might be causing her to unconsciously contract her toe muscles, which she thought she did unconsciously from time to time.  Lastly, I suggested that her slightly larger left foot coupled with the wearing of nylons in winter months might not be giving her toes enough room in her new shoes, causing them to curl back and rub the elevated joints against the top of her shoe.

Normally, the untrue causes can be quickly ruled out when they are found not to fit one or more of the problem description facts.  The first cause pertaining to fallen arches didn’t explain why only the left foot was affected, nor why the problem started fairly suddenly in the winter.  Plus, there was no visible evidence of a noticeable change in the curvature of her foot arches compared to prior years.  The second cause of unconscious tensing and contracting of her toes similarly didn’t explain why only the two middle toes were affected, and also why the left foot was more severely affected, nor why the problem suddenly started in the winter, months after starting her new job.  This left the final hypothesis: that her tight shoes, especially for her left foot which was a half shoe size larger, coupled with the wearing of nylons making them even more cramped for her longest toes which would naturally bend at the junction having the longest phalanges, as the likely cause.  It fit the facts perfectly, with virtually no assumptions necessary to explain both the ‘IS’ and ‘IS NOT’ information.  See the chart below for a summary of these final facts as we captured them in the problem analysis worksheet.

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Possible Cause Evaluation

Fortunately, the test to confirm—and hopefully correct—the problem was simple and fast.  All Pam had to do was undergo a trial period without wearing nylons and/or wear larger shoes to give her toes a chance to stretch out and allow the shortened tendons to return to their normal length.  Pamela did exactly that, and within a few short days her toe cramping disappeared entirely, and the angle of deformation on the second distal joint returned to near normal levels.  Because the elevated toe joints were no longer rubbing against the top end of her shoes, the bunions disappeared as well.  Today, Pam enjoys comfortable shoes and pain-free feet, without having had to resort to painful and no-reversal surgery.

As with many if not most other health conditions, the source of the problem can normally be found by carefully examining the history of the condition then looking for sources in the environment which are enabling or directly producing the problem.  Normally, a quick and painless fix can be applied without resorting to invasive drug or surgical treatment, or unnecessary medical testing.  When in doubt, it doesn’t hurt to take a few minutes to analyze the problem yourself and see if you, like Pam, might be able to bypass entirely the traditional medical system, with all the attendant discomfort, cost, and loss of personal privacy.  Live naturally and live healthily!

[If you believe you have a health problem which might benefit from this kind of self-analysis, you can download free copies of the worksheets presented in this article from my associated website: www.pinpointdiagnostics.net.  If you need any help navigating the worksheets, download my book Be Your Own Health Detective, shown in the sidebar to the right with a direct link to amazon.com—it guides you through the steps with many similar real-life examples.  Please share your successes solving your own health problems along with any additional comments and insights in the comment section below this post.]

By Reid Jenner

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