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Lesser Toe Deformity

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Mallet Toe

In this deformity the distal phalanx bends downwards at the distal interphalangeal joint and creates a mallet-like deformity. Second toe affects most frequently but it can affect all toes. It does not affect great toe.

Various factors are responsible for this. Few are unavoidable and some can be modified.

  • Repeated use of certain types of shoes like high heels, small and narrow toe box shoes can force the toes to bend and remain curled up for long enough that they may not be able to straight on bare foot.
  • Osteoarthritis and trauma

Toe become painful due to formation of corn and calluses at the dorsal aspect of deformity and toe tip. Sometimes wearing footwear becomes painful.

Hammer Toe

The middle phalanx bends downwards at its joint while the proximal phalanx forms a hammer-like deformity. 2nd, 3rd and 4th toe affect commonly. Sometimes the proximal phalanx bends upwards at the metatarsophalangeal joint then it is called complex hammer toe. To begin with the deformity is flexible but with time it becomes fixed.

Hammer toe deformity occurs due to muscle strength imbalance at the middle phalanx joint. Various factors are responsible for this weakness and imbalance. Few are unavoidable and some can be modified.

  • Repeated use of certain types of shoes like high heels, small and narrow toe box shoes can force the toes to bend and remain curled up for long enough that they may not be able to straight on bare foot.
  • Bunion/Hallux valgus deformity forces 2nd toe to develop hammer toe deformity
  • Longer 2nd toe than great toe has a greater chance of developing hammer toe
  • Female gender and old age increases the chance of developing hammer toe
  • Osteoarthritis and trauma can also develop hammer toe

Due to deformity, the upper surface of the PIP joint faces abnormal friction with footwear. The deformity itself pushes the ball of the toe downwards thus resulting in abnormal weight transfer at the sole aspect of the ball of the toes. Both these factors result in development of painful corns and calluses which makes it difficult to wear a normal foot ware even sometimes normal walking and standing.

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Claw Toe

It’s a condition in which your toes bend into a claw-like position. Here the proximal phalanx bends upwards (extension) on the metatarsophalangeal joint and other two phalanx bend downwards (flexion) on the interphalangeal joint. Claw toes can appear from birth, or your feet can become bent later on. It’s generally believed that claw toe is developed by wearing shoes that squeeze your toes, such as shoes that are too short or high heels. However, claw toe most often is the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the intrinsic muscles in your foot. Having a claw toe means your toes “claw,” digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time.

  • Neuromuscular diseases
  • Cavus deformity
  • Following delayed treatment or missed compartment syndrome
  • Regular use of small shoe with tight toe box and high heel

Self Care and prevention:

  • If your toes are still flexible, performing regular exercises of foot intrinsic muscle may help alleviate your symptoms or prevent them from getting worse
  • Moving toes passively toward their natural position can help improve the deformity.
  • Wearing shoes with soft, roomy toe boxes and avoid tight shoes and high-heels
  • Using friction protecting silicone gel cap, sheet and spreader also helps in preventing painful corn formation.

Based on your symptoms your doctor may advise you

  • A special insole or metatarsal pad that can redistribute your weight and relieve pressure on the ball of your foot as well as toe tip.
  • To wear a splint to keep them in the right position.
  • A surgical correction of toe deformity.