The biggest problem with foot pain, says Courtney Conley, DC, is that it stops people from moving.
“They won't want to go get the mail. They don’t want to walk around the block. It really takes a toll on their entire physical health and well-being,” says Conley, a specialist in foot and ankle health who treats and educates people through her organization Gait Happens.
Toe spacers – a low cost option that’s so easy to implement – can make a world of difference, especially in the context of a careful, professionally designed program of physical therapy for healthy feet, says Conley.
Correctly used, they encourage the development of natural space between the toes, which can help correct toe alignment, improve balance, and relieve pain, says Conley.
How Do Toe Spacers Work?
Inadequate footwear, irregular foot structure, and injuries can lead to a range of foot problems, such as bunions and hammertoe. Hammertoe is a deformity that causes an abnormal bend in the middle joint of a toe. Bunions are bony bumps that form on the joint at the base of your big toe. The bumps generally develop when bones in the front part of a foot are out of place.
And that can affect more than just your feet. If you have a forefoot deformity, your risk of falling is higher. In older adults with bunions, the fall rate is 62%, twice that of people without bunions, research shows.
Correctly used, toe spacers can help restore the “natural shape” of the foot, says Katie Lee, DPT, a Boston physical therapist who specializes in orthopedic conditions. The devices are one of Lee’s most commonly recommended tools for her patients, she says, especially for people with foot pain.
“I think anyone who’s having any foot pain or lower body problems like hip or knee pain could benefit from using toe spacers,” she says.
Recently, Lee treated a woman in her late 60s who was having sudden-onset forefoot pain, beneath the ball of her foot. Because of the pain, the woman couldn’t walk normally, says Lee, who owns Groundwork Physical Therapy. Lee recommended toe spacers, which the patient has been wearing now for about a month.
“She just came for a visit and said she notices when she wears her toe spacers at home, she notices the least amount of foot pain,” she says. “She can almost walk normally now.”
Toe Spacers Are Not a Magic Bullet
There is no evidence toe spacers by themselves can “fix” toe deformities like bunions, no matter how long you wear them, says Kevin Myer, DPM, a podiatrist and foot surgeon in Plano, Texas.
And, like any medical intervention, they can cause problems if incorrectly used. Myer has seen patients using separators who developed injuries from the pressure of the spacers. In one case, a patient with bunions developed a fracture in her foot in the area where the separator was pushing up against her second toe, says Myer, who practices at Graff Foot, Ankle, & Wound Care.
Myer worries that the recent spike in social media chatter and ads about bunion splints and toe spacers that can “correct” bunions could lead to an increase in such injuries. [Bunion splints are an orthotic device typically worn at night to help realign the big toe, while toe spacers can be worn during the day and/or with shoes to keep toes apart.]
“Deformities, including bunions, are structural,” he says. “You can use spacers to try to correctly align the toes, but they will never ultimately fix the problem.” The only way to correct bunion-related deformities, says Myer, is by surgically realigning the joint.
Conley acknowledges that wearing toe spacers will not get rid of bunions in severe cases. However, separators can slow down and prevent the progression of bunions and decrease pain and inflammation, she says. Their overall impact also depends on the severity of your bunions and what else you do to address the problem, she says. That’s why, says Conley, it’s so important to get an assessment from a qualified and educated foot specialist who can help you build the right foot care program.
An orthopedic physical therapist can help, says Lee, the Boston PT. Hands-on manual therapy can be beneficial in reducing pain for some people, she says. This can include soft tissue massage, dry needling, cupping, taping, and instrument-assisted soft tissue mobilization.
Ultimately though, therapy should make way for more active exercises focused on your individual needs like strength, mobility, coordination, or a mix of the three, Lee says. You can continue many of these exercises at home.
To develop a good foot health program, it’s a good idea to find a physical therapist, chiropractor, or functional podiatrist, depending on your needs.
Make sure the provider has the time available to talk through questions, get to know you, and follow up, Lee says.
“The best practitioner for you is the person that can explain what's going on to you in terms you understand and can help you learn the best and most realistic ways for you to invest in yourself actively,” she says.
The Shoe Problem
If you look at the majority of people’s feet, they look like they’ve been stuffed into a shoe for many years, Conley says. That’s because footwear, originally designed for protection, has given way to fashion.
Most toe boxes in footwear today are narrow and constraining, a design that binds toes together, she explains.
“When our toes are not allowed to splay or they don't know how to splay, which is the bigger issue, the health of our feet starts to be affected,” she says.
Careful foot care and therapy, including toe separators, can help keep these issues at bay and may also improve symptoms as well.
Separators are especially good for neuromas, says Conley. A foot neuroma is a painful swelling of nerves usually near the bones between the toes. Often, a neuroma will form a sheath around the nerve and it can split the toes, she says.
“When you put your foot that has a nerve that's irritated into a narrow toe box shoe, It's basically like squeezing the nerve,” she says. “So implementing toe spacers with patients who have nerve irritations in the foot can be extremely helpful.”
And make sure you use shoes that promote good foot function. Talk to a podiatrist or other foot specialist if you’re unsure what that means for you.
Myer (the podiatrist) says he would probably see half the foot and ankle problems he encounters if people wore better, more supportive shoes. Footwear like heels, cowboy boots, and shoes with narrow toe boxes often contribute to poor foot health. Wearing the right footwear also protects you from injuries if you accidentally step on sharp objects or walk on rocky ground, he says.
“Certainly anytime you’re in a river or walking around rough terrain, you should always have shoes on to protect your feet from stepping on foreign bodies,” he says. “Activities such as mowing the yard, riding a bike, or other activity barefooted or in flip-flops can lead to many problems. Protect your feet at all times.”
