Lesser toe deformity

Toes that are bent into an odd position at one or more of the joints tend to develop calluses, sores and bony lumps and are often inflamed, swollen and painful.  Lesser toe deformities can cause problems walking or participating in sports.  If they are not treated soon enough, the deformities become fixed and surgery is necessary to straighten them out.  

Tight shoes are the most common cause of this problem.  Two muscles work together to straighten and bend the toes and if shoes force a toe to stay in a bent position for too long, the muscles tighten and the tendons shorten or contract.  This makes it harder to straighten the toe.  Over time, the toe muscles cannot straighten the toe, even when barefooted.

Other common causes for lesser toe deformities include diabetes, poor blood supply to the foot, brain, spinal cord or nerve injury and arthritis.

The most common lesser toe deformities are:

All three bones in the toe should form a straight line.  With hammer toe, the first bone of the toe is slightly raised, the second bone is tilted downwards and the bone at the tip is almost flat.  It is the result of one of the tendons in the foot contracting.

All three bones in the toe should form a straight line.  With claw toe, the first bone in the toe is raised, the second two bones are pointing downwards.  It is the result of one of the tendons in the foot contracting.

All three bones in the toe should form a straight line.  With mallet toe, the first two bones of the toe are in line, but slightly raised and the bone at the tip is pointing downwards.  It is the result of one of the tendons in the foot contracting.

Any pressure on the deformed toe is painful.  Walking is painful and other problems may be caused as you adjust your gait to avoid the pain.  You may have redness and inflammation on the affected toe.

Physical examination and tests are used to diagnose toe deformities.  The surgeon measures flexibility, stability, and sensation in the toe and checks for redness (erythema), swelling and calluses.  X-rays will show the precise nature of the deformity.

Arthroplasty

Arthroplasty is used to treat claw, mallet and hammer toes.  The surgeon performs a number of minor procedures including releasing trapped or pinched soft tissue, and tendon lengthening to allow the toes to straighten.

Arthrodesis

If the deformity has been present for so long that the joint can no longer function properly, the joint may need to be fused.  This is done by removing the cartilage from the end of the toe bones in the middle joint, exposing the bone.  The two cut ends of bone are held in place with a removable pin so that the bones can fuse together.

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