Lesser Toe Deformities

Common Symptoms

Lesser toes are defined as digits 2-5 on the feet, deformities within this area may result in discomfort, pain, inability to fit into footwear, nail damage, excessive callous formation and in some cases wounds or ulcerations may occur.

How it occurs
Lesser toes are composed of four joint’s that connect four small bones together with each toe encompassed by muscle, tendon, blood vessels, veins, nerves, and other connective tissue. Within these joint spaces three deformities known as, mallet, hammer and claw toes may occur. 

As seen in the image, mallet toe causes the joint closest to the nail to curls downward. Whereas a hammer toe bends abnormally within the middle toe joint and visually appears as though it is elevated off the ground. Claw toe is the most severe deformity with all four joints causing the toe to curl underneath the foot.

Other factors that may support the development of lesser toe deformities include:

-          Imbalances between the intrinsic and extrinsic foot musculature

-          Inappropriate footwear, shoes that are too short in length and narrow in width

-          Comorbidities such as, diabetes, peripheral motor, sensory or autonomic neuropathy and rheumatological conditions such as, systemic lupus erythematosus, osteoarthritis, and rheumatoid arthritis

What we may assess to obtain a diagnosis
Diagnosis is always subject to symptomatic complaint in conjunction with clinical testing performed by your podiatrist. Test performed may include touching (palpation) the painful area, joint range of motion to assess if the deformity is rigid (bone related) or flexible (muscle related) and an assessment of your walking or running (gait).

At The Running Room and Posh Pod, we are equipped with a pressure plate treadmill (Zebris) allowing us to comprehensively assess plantar pressures within the feet. Additionally, your podiatrist may send you for radiographic imaging to assess the severity and/or degree of the deformity although, this is not always necessary.

Management and how long does it take?
Lesser toe deformities that are rigid and of bone origin are generally permanent whereas flexible deformities of muscle origin are not. Management and treatment time frames vary on a case-by-case basis. Conservative care requires both monitoring and symptomatic relief whereas, post-operative recovery ranges between 2-6 weeks.

Conservative modalities may include footwear adjustments, custom orthotics, off-loading such as, gel-selves, otoform devices and semi-compressive felt padding with taping techniques reserved for flexible deformities only. General podiatry is required to maintain skin integrity, reduce excessive callous or corn development and to minimise the risk of nail deformity.

If conservative treatment fails surgical intervention maybe considered in collaboration with your general practitioner where an appropriate referral will be made. Post-operative treatment can be provided by your podiatrist and may include a combination of foot specific exercises, footwear adjustments, custom orthotics, and routine skin/nail podiatry care.

Author: Maddie Parker

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