One of the most common questions regarding the use of toe separators is “How long does it take for them to work?” And as you might expect, the answer is: it depends.

There are many different factors that will influence an individual’s success with toe separators and this article aims to highlight some of the most prominent. Most aspects will fall into one of two categories: Personal Factors, including the individual’s current foot health status and foot health goals; and Product Factors, which depend more on the quality of the products or tools used and how they’re utilized.

Immediate Relief & Long-Term Impact

If toe separators are used appropriately and effectively, a typical success timeline might look like this:

• Immediate – 1 Month | Increased foot/ankle stability through improved structural alignment. Relief from minor aches and pains. Expect mild muscle/joint soreness as toes change position and dormant muscles become more active.
• 3 months – 1 Year| Improved toe dexterity/control and increased foot/toe muscle strength and volume. Relief from moderate aches and pains. Expect cycles of soreness and strength as muscles continue to build. Anticipate adding a shim to progressively reverse bunions.
• 6 months – 3 Years | Significant toe/foot strength gains and lasting architectural/aesthetic changes. Relief from significant aches and pains.

Personal Factors

When it comes to estimating timelines for foot and toe rehab while using toe separators, we start by evaluating the current health status of the feet. It may seem obvious, but feet with more severe bunions, bunionnettes, and hammertoe deformations will face longer roads to recovery than feet starting out with less severe problems. A healthy foot ideally has the toe bones in a straight line with the foot bones (metatarsals)—so the greater the angulation between the toe and foot bones becomes, the more work that needs to be done to correct them.

Similarly, it’s also important to consider the individual’s foot health goals in determining a target endpoint. Most people simply want to reduce and eliminate pain, while others seek to develop strong and muscular feet, and yet some people desire mostly aesthetic changes. On a typical timeline, we first see improved stability through more optimal alignment, followed by strength gains as pain resolves. The aesthetics often take the longest and it’s not always possible to completely reverse foot and toe deformations back into a state of ideal foot alignment and posture.

Some other personal factors influencing success with toe separators are genetics, age, overall health. It’s important to note that bunions or other similar toe deformations are NOT hereditary. However, what is inherited is the make-up and properties of the musculoskeletal system that might predispose you to bunion formation. People with more lax ligaments, muscles, and fascia tend to have feet that more readily deform into the shape of unhealthy footwear (tapered toe box) and thus will require more effort and time to reverse. Conversely, the foot of someone with more elastic soft tissues tends to more easily spring back into shape once removed from poorly shaped shoes. Beyond footwear choice and activity level, this is the main difference between why one person might develop bunions and another won’t. Along the same line, the shape and size of bones are also inherited and there’s good research showing that gait can be inherited as well—both of these will certainly influence an individual’s potential for bunion formation.

As we age, our body’s ability to change and repair itself starts to slow down. This doesn’t mean that older and more experienced folks can’t make changes to their feet, just that the timeline is longer when compared to an adolescent or young adult. Overall health, including systemic diseases and body weight, also plays a role in determining success with toe separators. Autoimmune diseases like rheumatoid arthritis and Marfan’s Syndrome and metabolic diseases like diabetes and gout will absolutely influence foot health, often making the route to recovery a little more challenging.

 

Product Factors

The other half of the toe separator success equation involves which products and tools you use and how you use them. There are dozens of different types of toe spacers available, and not all are created equally.

Quality of Material – Most toe separators are made of silicone, but not all silicone is the same. Correct Toes are made from anti-microbial medical-grade silicone and tend to be more firm than other brands of toe separators, but that doesn’t necessarily mean they’re “hard,” per se. Actually, other toe separators are really soft—at times too soft. The toe separator brands that use softer, cheaper, gel-like silicone blends are much more elastic; the consistency is similar to those stretchy “sticky hand” toys found in gag gift shops and 50-cent toy machines. You’ll notice whether these one-size-fits-all toe separators come in blue, green, black, or clear, they’re pretty much all the exact same product. The problem with using such a soft material to separate the toes is that many bunions are so set in their ways that they will overpower the soft gel spacers. The elasticity does allow these kinds of toe separators to be worn on many different sizes and thicknesses of toes, however, because the toe-holes on these types of toe separators are so small, it can often feel as if there is a rubber band wrapped around each toe in addition to the gel-like spacers between the toes. This sort of combination of squeezing the toes individually paired with compressing them into the gel separator that is attempting to space the toes is uncomfortable for many and painful for some, even though these spacers are softer. Correct Toes are firm enough to push back against even the strongest of bunions, yet are still soft on the skin.

 

Anatomical Fit – Correct Toes were designed by a sports podiatrist to anatomically space the toes—which means aligning the toes with the foot bones. To accomplish this effectively, Correct Toes comes in 4 different sizes that are easily modifiable for further customization to the user’s unique foot. Other toe separators tend to space the toes arbitrarily and some are too bulky, splaying the toes past the point of alignment. If the pre-determined toe separator size on the one-size-fits-all models doesn’t match up with what your unique feet need, they can actually do more harm than good. If we’re not aiming for ideal alignment, then what are we even doing?

Toe separator success is also heavily influenced by both the amount of time you wear them and the intensity of the activity they’re worn during. It takes many steps in unhealthy footwear over a long period of time to change the shape of our feet and form bunions, hammertoes, etc. Feet that take more steps, and especially feet that take more athletic steps (e.g. runners, hikers, and other foot-centric athletes), change much faster. To improve the chances of success with toe separators, we need to wear them often and be active in them. As always, it’s important to start low and increase slowly. In most cases, 30 minutes of passive wear on the first day is a great starting point. From there increase the time toe separators are worn by 30 minutes per day, as feet tolerate.

Also slowly increase the intensity of the activities toe separators are worn during. For example, one might start by wearing them passively while sitting on the couch on the first day. The next couple of days could involve more weight-bearing activities like walking around the house or yard. From there, toe separators can be worn for longer walks, runs, hikes, yoga, gym work, sports and so much more. Toe separators are simple tools to help you realign and strengthen your feet, but they won’t work without effort from the user.

Since most people don’t spend much time exercising while barefoot, it’s a good idea to have a pair of shoes that are compatible with toe spacers that you can also exercise in. Attempting to wear toe spacers in conventional shoes with a narrow tapered toe box will NOT work. Similar to how elastic toe separators can painfully pull the toes inwards into the spacers, so will a narrow toe box squeeze the toes into the spacers between the toes. The Shoe Liner Test is a great way to evaluate footwear. Stand upon your shoe’s insole with toe separators on to see if that shoe’s toe box is wide enough to fit your toe separators.

Performing additional foot health mobility and strength exercises will also improve chances of success. Some great mobility exercises include interlacing fingers between toes, the bunion stretch and soft tissue release, the toe extensor stretch, and rolling the bottom of the foot on a lacrosse ball. And here are 5 foot strengthening exercises that pair well with toe separators. It’s important to remember that this process of realigning and strengthening the feet takes a lot of time, patience, effort, and dedication. As with any training program, there will be up and downs—it’s never a straight path. If you take on this journey, take pictures of your feet before because progress is incremental and we’re seeking an aggregation of marginal gains. By applying the information in the article to yourself, you can tip the scales of success in your favor.

 

Written by: Dr. Andrew Wojciechowski, ND

If you’re seeking more individualized foot health care and would like to work with Dr. Andrew directly, you can schedule at Northwest Foot and Ankle.

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