From the Guidelines
The use of toe spacers or similar orthotic devices, such as toe silicone or (semi-)rigid orthotic devices, may be considered to help reduce excess callus on the toe in persons with diabetes at risk of foot ulceration, as suggested by the 2023 update of the guidelines on the prevention of foot ulcers in persons with diabetes [IWGDF 2023 update] (1). When considering the treatment of foot conditions such as bunions, hammertoes, or toe crowding, it's essential to prioritize interventions that improve morbidity, mortality, and quality of life.
- The primary goal is to prevent foot ulcers, especially in individuals with diabetes, as they can lead to severe complications.
- Orthotic interventions, including toe spacers, can be a valuable adjunct to other treatments, helping to reduce pressure and friction between toes.
- However, it's crucial to note that these devices should be used under the guidance of a healthcare professional, as improper use can exacerbate the condition. Some key points to consider when using toe spacers include:
- Starting with short wearing periods and gradually increasing the duration as tolerated.
- Potential benefits include reducing pain and discomfort by separating toes and improving alignment.
- Toe spacers may be most beneficial when used in conjunction with other treatments, such as proper footwear and stretching exercises. It's also important to recognize that while toe spacers can provide symptomatic relief, they may not address the underlying cause of the condition, and more severe deformities may ultimately require surgical intervention, such as digital flexor tendon tenotomy, as recommended in the guidelines (1).
From the Research
Evidence for Toe Spacers
The use of toe spacers, also known as orthotic devices, has been studied in the context of treating foot conditions such as bunions, hammertoes, and toe crowding. The evidence suggests that:
- Toe spacers can be a useful tool in the non-operative management of bunions, as they can help to reduce pain and improve symptoms 2.
- Orthotics, including toe spacers, can be used to alleviate symptoms of lesser toe deformities, such as hammer, claw, and mallet toes 3.
- Physiotherapy-based approaches, including the use of orthoses and corrective devices, can be effective in correcting less severe deformities and preventing them from worsening 4.
- Toe separators, a type of toe spacer, have been shown to be a valuable tool in the conservative treatment of hallux valgus and associated deformities, with promising results also in neurology and dermatology 5.
- Strengthening foot muscles, which can be aided by the use of toe spacers, may help to reduce pain and improve mobility in individuals with bunions 6.
Types of Toe Spacers
The studies reviewed suggest that different types of toe spacers can be used, including:
- Custom-made silicone orthoses applied at the second digit metatarsophalangeal (MTP) joint 3.
- Metatarsal pads placed proximal to the second metatarsal head 3.
- Toe separators made of various materials, with varying methods of application 5.
Limitations and Future Research
While the evidence suggests that toe spacers can be a useful tool in the treatment of foot conditions, there are limitations to the current research, including: