Those Long Second Toes
By DrStoll
July 23, 2012
Category: Uncategorized
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Runners, Sprinters, Cyclists, Climbers, Tennis players, and all those who play indoor and outdoor sports have come into my office with a big blue blood blister underneath their second toenail.  Sometimes, they are in my office saying that for some reason the toenail of the second toe falls off all the time!  This is a common ailment where the second toe is just longer than the other toes.  Sometimes, we are born this way.  Sometimes this happens because we pound our feet into shoes that we are not supposed to and the bones and tendons bend to try to adjust to them.  This sometimes causes the end part to the toe to contract and you get a blister under the nail or at the tip of the toe. 
Over time this adjustment that your bady makes causes the toe to permanently contract and thus the "Mallet Toe" is formed.  A mallet toe is the contracture of the end joint of the toe.  This is different from a "hammerrtoe" where the first joint of the toe is contracted.  A mallet toe usually doesn't hurt on the top, it hurts on the bottom.
Usually, warm water soaks and rest will help the pain of these blisters and sores.  Of course if you have Diabetes or Poor Circulation you need to be seen immediately. 
The question remains for the patients that want to keep an active life and have tried longer shoes, how they can combat this.  Digital Shortening is a procedure that is medically indicated and usually covered under insurance policies.  This relieves the problem about the length of the toe, and also permanently fixes the trauma that is taken to the nail and tip of the toe.
Digital Shortening requires very little downtime, and patients are usually walking  the next day in a special shoe for 3 weeks.  With modern technology, a small implant is placed into the toe which hold the toe straight, and a small section of the toe bone is removed that will not be missed.  There is usually no visible scar because the incision is along a crease in the skin that is hidden anyway.



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