Our Second Date: Stroke Can Make Your Toes Curl

Once we'd moved beyond the Social Security office adventure that began our first date, we found ourselves entering into an even more physically revealing experience. We stopped at the cafe where Bruce worked and got his paycheck. Then we went to a local mall to visit a shoe store where he could get new tennis shoes.

He selected the shoes that were identical to the ones he was wearing and sat on one of the benches. He removed his shoes and a wadded-up insole fell out. I had noticed that he kept reaching down and pushing something back down into his shoe as we walked. Now that I could see the problem, I wondered what it was for. He then quickly removed his sock and began to rub his foot.

I immediately noticed the large salicylic acid pad wrapped around his big toe. It was entirely too large for the area being treated and had slipped loose. At this point, it was probably causing rather than relieving his pain.

"What happened to your toe?" I asked.

"I don't know. It just hurts. I have Jewish feet."

The big toe, called the Hallux, is made up of two small bones called phalanges. Hallux Hammer Toe presents as a cocking up of the big toe at the joint between these two small bones. It is caused by a variety of conditions and is commonly seen in patients after they have suffered a stroke. Resulting muscle weakness or muscle imbalance in the muscles of the lower leg can result in the formation of Hallux hammertoe.

A consequence of having a Hallux hammertoe is irritation on the top of the toe from shoe pressure or the development of a painful callous on the end of the big toe. People who have had a stroke may not [necessarily] have pain associated with the callous on the end of the toe.

I looked to see if I could spot what "Jewish Feet" looked like. He had taken his sock off to fix the callous pad. In addition to the ulcerous looking sore on the tip of his big toe, I couldn't help but notice that a couple of his middle toes were malformed. I knew that the sore on the tip of his big toe was probably a callous or a corn. The curled up toes were a mystery to me.

Medicine Net defines hammertoe as a common deformity of the foot in which either the second, third, or fourth toe is bent at the middle joint, so that the tip of the toe is bent downward while the middle of the toe is cocked upward resembling a hammer. The hammertoe deformity is the most common deformity of the small toes.

A few days later I visited Bruce's apartment after work. He had invited me to dinner. He was finishing the creation of a larger-than-life salad when I arrived. I requested a basin or bucket to hold a few inches of water and he showed me a big red mop bucket. When I asked where I could find a towel, his curiosity increased and he pointed to the bathroom. I found a large, fluffy, gray bath blanket hanging on the towel rod.

As he continued to prepare our dinner, I poured the Epsom salts I had brought into four inches of hot water in the bucket, gathered a few items from my bag and returned to the living room. I then asked him to sit in his recliner and remove his shoe and his sock. He couldn't lift the foot and place it in the water without spilling the bucket. I scrunched up his pant leg, securing it above his knee and carefully lifted and set his foot in the water.

I sat at his feet and we talked about everything in the world while his foot soaked for 15 to 20 minutes. Then I removed his foot from the water, placed it in the towel on the floor and covered it while I emptied the bucket. He started to reach to dry his own foot but couldn't manage to reach it. I carefully patted it dry as I didn't know how or where it truly hurt.

I'd brought an exfoliating foot cream which I used over the entire foot. The soles of his feet were smooth when I was finished but the callous was incredibly tough. I had brought a pumice stone and tried to use it on his big toe but the sensation was not pleasant for him. In a small bottle, I had a combination of essential oils prepared for the relief of pain. I slowly massaged the oil into his foot. I finished by painting a couple drops of salicylic acid liquid across the callous and bandaging his toe with gauze and tape. I slipped one of the corn rings, a padded doughnut shaped piece of foam, to keep his shoe from rubbing against the sore. Then I slipped a clean sock onto his foot.

Stroke can have various effects on the body. A stroke can even curl your toes. Some common effects of the stroke include claw toe and hammertoes. Hammertoes or claw toes are caused by an imbalance of muscles in the feet and toes. The muscles in the foot are stronger than those in the toes. Patients may also develop blisters on the affected toes and calluses on the ball of the foot. The Heart and Stroke Foundation suggests that stroke patients check their feet daily for cracks, blisters, sores, swelling or changes in skin color. Inspecting his own feet would be an impossible contortionistic feat.

Bruce's foot massage had called my attention back to those numerous deformed toes I'd discovered at the shoe store on our first date. I asked him if he had pain with those as well. Apparently he had a history of difficulty with his feet since the stroke. He had one pair of orthopedic shoes in his closet that were so dusty the leather could not be seen. The heels had worn down from walking and the cost to repair was well above his means. It was funny how he felt that just owning the shoes was all that was needed to keep his feet healthy! We would discuss that topic a different day.

Signs and symptoms of hammertoe and mallet toe, according to the Mayo Clinic, may include:

** A hammer-like or claw-like appearance of a toe
** In mallet toe, a deformity at the end of the toe, giving the toe a mallet-like appearance
** Pain and difficulty moving the toe
** Corns and calluses resulting from the toe rubbing against the inside of your footwear
** Both hammertoe and mallet toe can cause pain with walking and other foot movements.

In another article provided by the Mayo Clinic it has been shown that "Aside from wearing crowded shoes, hammertoe and mallet toe may result from muscle and nerve damage (neuropathy) caused by conditions such as... stroke... Relieving the pain and pressure may involve changing footwear and wearing shoe inserts. More severe cases may require surgery."

Bruce told me that he previously had surgery on his good foot but needed a surgery on his stroked foot. He said that the doctors wanted to break two toes and put them back "in the proper way." He wasn't able to have the surgery because he would need to stay off the foot for up to six weeks. For able-bodied people, this would mean the use of crutches or a walker. For Bruce, this was very nearly out of the question. One arm and hand along with one leg and foot were unable to function properly under the best of circumstances. Asking him to balance on a set of crutches with an injured foot was unimaginable. I could only relate it to walking, talking, chewing gum, patting your head, and rubbing your belly at the same time.

We repeated the foot massage, medication and bandaging nearly every night for three weeks. Each time, a dinner would be waiting, the bucket and towel would be beside his chair and a joy filled smile would fill his face when I got to the door. It was only a matter of time.

It was only a matter of time before the callous fell off his toe and we fell in love.