Foot health is essential for overall well-being, yet we sometimes endure discomfort to wear fashionable shoes until we start experiencing pain or notice deformities. Claw toe, hammer toe, and mallet toe are common conditions that can make walking painful and they can change how your feet look. Recognizing lesser toe conditions early can help you alleviate these common foot problems.
Recognizing the problem
Three small bones—the distal, middle, and proximal phalanges—form the lesser toes. The joint between the distal and middle phalanges is the distal interphalangeal joint (DIP); the joint between the middle and proximal phalanges is the proximal interphalangeal joint (PIP); and the metatarsophalangeal joint (MTP) connects the toe to the foot at the metatarsal bone. Two tendons—the extensor digitorum longus (EDL) and flexor digitorum longus (FDL)—allows the lesser toes to flex (bend) and extend (straighten) (Fig. 1). Determining a toe deformity depends on how the joints are flexed or extended while at rest. (Figs. 2 – 4)
Causes
These toe deformities can result after an injury to the joints and tendons and some, namely claw toe, has been linked to chronic conditions like diabetes and alcoholism. However, the most common cause for these deformities comes from wearing shoes that do not fit properly. Wearing the wrong size shoe or a shoe with a narrow shoe box can place your toes in unnatural and uncomfortable positions. Doing this day after day can lead to permanent changes in your foot anatomy, which leads to your toes remaining in an abnormal position after removing the shoes. For this reason, toe deformities are more common in women who spend their days in high heels and small toe boxes. Besides shoes, the lesser toe deformities can result from trauma, genetic abnormalities, and arthritis.
Symptoms
Apart from appearance, most patients experience irritating corns, calluses, or wounds caused by contact and friction within the shoe. In mallet toe, for example, the DIP bends to the point where the tip of the toe rubs into the ground when walking. The skin becomes sensitive and you experience pain with each step. When the top of the toe bends upward, it can rub against the top of a low toe box causing additional blisters and raw skin.
Treatment
When dealing with toe deformities, it’s best to start with nonsurgical treatments; however, if the condition worsens, then surgical intervention may be necessary. For most patients, getting shoes with a high toe box can help alleviate discomfort. A larger toe box stops the problem of the toes crammed into a small area forcing the joints into unnatural positions. Your doctor may also recommend you use toe sleeves to provide cushion between the toes and the shoe or sock. For claw and sometimes hammer toe, if the PIP joint is still flexible, your physician can apply tape to the toe to hold it straight. This prevents the joints from contracting further and helps loosen the muscles and tendon causing the deformity. Unfortunately, if these options are unsuccessful and issues continue to persist, surgery may be the best choice.
If the joints are still flexible, surgery to lengthen the tendons allows the toe to return to the correct position. The surgeon can also transfer the tendons from areas where the pull is too strong to an area where the pull is too weak to correct the imbalance of the forces on the toes. Finally, if the joints have been in their abnormal position for too long and have become inflexible in these positions, arthrodesis (fusion of the joint in the straight position) may be necessary (Fig. 5). The surgeon lengthens the tendons while also removing a part of the bone at the joint and inserting a pin through the entire length of the toe. The pin remains until the bones on either side of the joint have fused together to prevent any movement of the toe at that joint. In this scenario, the toe will still be unable to move at the joint, however, it should be in a position that causes less pain.
Don’t wait
Pain and appearance are what often lead people to seek medical advice about toe deformities. However, some people avoid seeking help, allowing their deformities to worsen. This can lead to a number of more serious issues, such as infection from untreated abscesses, and wounds developing on other parts of the foot from changes in the way you walk. You may even begin to have issues with balance. Not to mention, the longer you wait to have your condition treated, the more difficult the treatment and recovery becomes. When symptoms start, don’t wait. See an orthopaedist and start making the small changes before you need more extensive treatment.
Author: Ethan Harrison, BS | Columbus, Georgia
Last edited on December 10, 2024