What are lesser toe deformities?
This is one of the commonest problems in the foot. A ‘claw toe’, ‘hammer toe’ and a ‘mallet toe’ are all variations of deformities to the lesser toe. They all cause bending of the toes at its different joints causing problems with cosmesis or rubbing of the toes within footwear causing problems. The figure above shows the different deformities which may be seen in the lesser toes.
What causes lesser toe deformities?
• Neuromuscular problems - A lesser toe deformity is caused due to a muscle imbalance in the foot which is usually seen in neurological conditions such as Charcot Marie Tooth disease.
• Inflammatory conditions like rheumatoid arthritis may cause damage to the soft tissues and tendons around the toes which may also contribute to these deformities.
• A bunion may push against the second toe cramping it for space and cause a deformity to the second toe.
• Ill fitting or tight shoes may also cause the toes to bend putting increased pressure on them and causing clawing or hammering of the toes.
What are the symptoms caused by this condition?
Difficulty with shoewear is the commonest complaint. Patients complain of their shoes rubbing against their toes. This particularly occurs at the top of the toe knuckle causing a thickening of the skin called a ‘callosity’. Corns may develop on the ball of the foot due to an abnormal amount of pressure passing through this area. There may also be pain in the ball of the foot.
How is this condition diagnosed?
Your consultant will examine your foot clinically and this usually makes the diagnosis clear. X-rays will be taken to determine whether there is any underlying arthritis in the long ray of the foot which may contribute to this condition.
Can the condition worsen?
People function normally with this problem for years without any symptoms. Initially the deformity in the toe will be ‘flexible’. This means that you will be able to manipulate the toe and get it straight. But as time progresses the deformity might become ‘fixed’. The callosity on the toe knuckle might break down and ulcerate due to constant friction from shoe wear.
What treatment options are there?
Options are based on the degree of severity of symptoms. Most patients are seeking advice and reassurance. Non surgical options are
Foot wear modification:
Awide toe box will prevent the toes from rubbing against the shoe. Toe splints may also be employed and your consultant will explain to you the options available with these.
Surgery is the last option to be employed if non surgical treatments have failed. The commonest option employed is a fusion of the toe joint. This is a relatively minor surgical procedure where the toe is straightened out and fused with a pin. Further information on this procedure is available under lesser toe surgery in surgical procedures.
Is surgery necessary?
The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. The majority of patients will benefit from shoe wear modifications. If symptoms continue to affect lifestyle and function inspite of this then surgery may be discussed with your consultant and he will advise you regarding the pros and cons of surgery.