Common Toe Deformities

What is the normal anatomy of the foot?

Anatomically, the foot is divided into the forefoot, mid foot and hind foot. The forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Each of the phalanges have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The mid foot and hind foot have different structures, which are responsible for bearing body weight and performing activities such as walking and running.

What are toe deformities?

Toe deformities are common problems that occur due to the abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis that affect the bones and tissues of the foot. Toe deformities not only affect the alignment of the bones, joints and tissues in the foot, but may also affect alignment of the weight-bearing joints such as the hips or knees, resulting in further problems. The most common toe deformities are hammertoes, claw toes and mallet toes.

What are the causes of toe deformities?

Toe deformities can be congenital, present at birth, or can occur later in life from wearing improperly fitted shoes or high-heeled shoes. Certain diseases or conditions, such as diabetes, stroke, osteoarthritis and rheumatoid arthritis, affect the functioning of muscles and nerves, and can cause tightening of ligaments or tendons, resulting in these deformities. In some cases, accidents or injuries can result in fractures and lead to toe deformities.

What are common signs and symptoms of toe deformities?

The symptoms associated with hammertoe, claw toe and mallet toe are similar and include feeling pain while wearing shoes and having difficulty finding properly fitted and comfortable shoes. Improperly fitting footwear can result in hard skin outgrowths from high pressure and friction.

At the onset of the problem, the deformed toe is usually flexible; however, if left untreated, it can become rigid and immovable, requiring surgical treatment. Therefore, it is recommended to see your doctor for early treatment measures.

What are characteristics of common toe deformities?

In case of hammertoe, the toe is bent at the middle joint, leading to curling of the toe to resemble a hammer. Hammertoe is commonly seen in the second toe but can affect other toes as well. Another related condition called a bunion is often seen along with hammertoe and involves a bony outgrowth along the side of the foot at the base of the big toe.

Claw toes exhibit an upward bending of the toe joint at the ball of the foot, followed by the toe bending downward in a claw-like fashion at the middle joint and sometimes end joint. Claw toe can occur in any toe except the big toe.

Mallet toe is similar to hammer toe, except that the joint involved is the upper joint instead of the middle joint, giving the toe a mallet-like appearance at the end of the toe.

How are toe deformities diagnosed?

Toe deformities are simply diagnosed by a physical examination of the toe, and usually no diagnostic test is required. However, in cases where your physician suspects nerve involvement, then special tests may be ordered.

How are toe deformities treated?

Initially, toe deformities are treated with conservative treatment measures to restore or maintain walking ability, relieve pain, and also delay the progression of the deformity.

Conservative treatment includes wearing specially designed shoes with cushions or pads with an enlarged toe box area to prevent skin breakdown. You will be instructed to avoid wearing tight, narrow or high-heeled shoes. Splints or tape may be applied to reposition the toes, and regular toe stretching exercises are also recommended.

Surgical treatment is recommended if conservative treatment fails to relieve symptoms, or the deformed toes become rigid and immovable. The main objective of surgery is to restore the normal toe alignment and return the foot to its normal pain-free function. The surgical procedure is chosen based on the stability of the deformed toe: whether it is flexible or not.

If some flexibility exists in the toe, then the surgeon will make an incision over the deformed toe joint and realign the tendons and ligaments. Pins may be placed to keep the toe in position while healing. The incision is then closed with sutures and covered with a sterile dressing.

In cases where the deformity is rigidly fixed, the surgeon will make an incision over the joint of the deformity, realign the tendons and ligaments, and also perform an osteotomy (removal of bone pieces). Pins are also inserted to keep the toes aligned while healing. Finally, the incision will be closed with sutures and covered with a sterile dressing.

What are the risks and complications associated with the surgical treatment of toe deformities?

Apart from general complications linked with any surgical operation, other specific complications include inadequate correction of the deformity and stiffness of the toe. Loss of blood supply to the toe and damage of the surrounding nerves is rare but may also occur.

What is the post-operative care required following the surgical treatment of toe deformities?

Apart from the general guidelines given by your surgeon after any surgery, specific instructions following toe deformity surgery include wearing a special post-op shoe for at least 2-6 weeks to prevent bending the operated toe.

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