Pincer Toe nails: You've seen them; did you know what they were and how they got that way? Or, did you dismiss them?

We think Hitomi’s hypothesis is correct. Here is why (this is paraphrased from our blog post on subungal hematomas and our revolutionary thinking on why they occur and it seems to fit well with pincer nail formation as well).

… when the skin is pulled at a differential rate over the distal phalange (from gripping of the toes rather than downward pressing through the toe pad) there will be a net lifting response of the nail from its bed as the skin is drawn forward of the backward drawn phalange (there is a NET movement of skin forward thus lifting the nail from its bedding). For an at-home example of this, put your hand AND fingers flat on a table top. Now activate JUST your distal long finger flexors so that only the tip of the fingers are in contact with the table top (there will be a small lifting of the fingers). There should be minimal flexion of the distal fingers at this point. Note the spreading and flattening of the nail. Now, without letting the finger tip-skin contact point move at all from the table, go ahead and increase your long flexor tone/pull fairly aggressively. You are in essence trying to pull the finger backward into flexion while leaving the skin pad in the same place on the table. Feel the pressure building under the distal tip of the finger nail as the skin is RELATIVELY drawn forward.] This is fat pad and skin being drawn forward (relative to the phalange bone being drawn backward) into the apex of the nail. Could this be magnifying the curvature of the nail and not offsetting the “automatic curving and shrinkage” function of the nail ? We think it is quite possible.

We have more to say on this topic, the above is just an excerpt of our blog post. More here, in the link below

Flexible hammer toes

IF you've been with us all along you know this one by heart. All you have to do is test it to confirm (never assume, ever !). 
And remember, sometimes people present with their problem, and sometimes they present with a layered compensation to strategize and cope with the underlying problem. It is your job to determine that.
You must recognize here:
flexible hammer toe early development. It is a compensation for weakness somewhere in the chain. It is a gripping strategy to make up for something somewhere. It is not normal, it is a clue.

1- over activity of the short extensors & and long flexors
2- under activity of the long extensors & and short flexors
3- thusly, distal displacement of the Metatarsal fat pad complex
4- and lotsa other things (but we will not detract from the major cursory observation point here today)

Loading this forefoot is troubled, in many ways...... so many that we will not go it here. We have written about these things in long form so many times, just head over to the blog and search. This client did not have any foot or ankle issues, they had impaired hip rotation and extension and were complaining of low back pain. They have obviously been coping through the entire chain for awhile. Be Sherlock Holmes in your practice today, look for the clues.

-Dr. Allen