Toe deformities are common problems that can occur for a variety of reasons. They may be a congenital problem, the result of an injury, the consequence of ill-fitting footwear, or the result of diseases that affect the bones and tissues of the foot. Toe deformities can become a source of pain and discomfort that may lead to disability as well as more far reaching problems. The most common toe deformities include hammertoes, mallet toes, and claw toes.
The foot is a complex structure made up of some 28 bones, 30 joints, and more than one hundred muscles, tendons, and ligaments. These components facilitate actions that include standing, walking, running, and jumping. The feet help transmit the body’s weight to the ground and assist in maintaining equilibrium when in an upright posture.
The toes are part of the forefoot and contribute to the balance and weight bearing functions of the feet, as well as help to provide thrust when necessary for efficient walking, running, and related activities. The bones of the toes are known as the phalanges.
The most common toe deformities include:
- Hammertoe: A deformity in which the toe is contracted at the middle joint. It may occur in any toe with the exception of the big toe
- Mallet Toe: A deformity with a contracture or bending downward of the end joint of the toe.
- Claw toe: A deformity of the toe where there are multiple contractures. It is bent upward (extension) at the base of the toe, and bends downward with contractures at the middle joint and end toe joint.
Although these toe deformities may have developed for different reasons, they are all progressive. If left untreated or aggravated by footwear they can worsen. Toe deformities may promote the development of associated problems like corns, calluses, or bunions, as well as problems for other weight bearing joints such as the knees and the hips.
The diagnosis of these three common toe deformities can often be made based on a physical examination of the toes. However, additional tests may be ordered if nerve involvement or other problems are suspected.
Initial treatment typically involves conservative measures that are directed towards the relief of pain, the restoration or maintenance of walking ability, easing pressure and friction, and delaying progression of the deformity. Achieving these goals may include wearing appropriately designed footwear that provides move space, cushions and pads for the relief of pressure, splints or tapes to reposition the toes, and toe stretching exercises.
In cases where the conservative treatment has been unsuccessful in relieving symptoms, or when the involved toes have become rigid and immovable, surgery may be recommended. The aim of a surgical procedure is to correct toe alignment and to restore function.