FOOT & ANKLE

Toe Deformities

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. 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.

Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics, and diseases such as arthritis affecting 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.

Claw Toe

Claw toe is a deformity, where a toe bends and appears like a bird’s claw. It develops when there is an imbalance between the intrinsic and extrinsic muscle systems of the toe, resulting in altered anatomy. This can be due to external force, claw toe can also occur in the four toes other than the big toe due to nerve damage, which weakens the muscles. The affected toe is bent upward from the joint at the ball of the foot, and downward at the joints in the middle and tip of the toe to curl under the foot. Hard thick skin called corns may develop under the ball of the foot or on the top of the affected toe, causing pain while walking. Claw toe may be present at birth or acquired later due to disorders such as rheumatoid arthritis, cerebral palsy and brain injury. Women are often affected more than men as claw toe can also form by wearing very tight or high heeled shoes.

Hammer toe

Hammer toe is a deformity of the second, third or fourth toes where it is bent at the middle joint so that it resembles a hammer. It can result in pain on top of the toe knuckle (proximal interphalangeal joint) and also the tip of the toe and can cause corns. Hammer toe is the result of a muscle imbalance that puts pressure on the toe tendons and joints. If the toe is bent in one position long enough, the muscles and joints tighten and cannot stretch out.

Mallet Toe

Mallet toe is similar to hammer toe except the joint involved is the upper joint instead of the middle, fiving the toe a mallet-like appearance at the end of the toe. It can occur in the same mechanism and if left untreated can cause pain when walking.

Symptoms

Symptoms of toe deformities are similar and include:

  • Swelling and redness
  • Inability to straighten the toe
  • Pain wearing shoes
  • Corn or callus on the affected joint or tip of the toe
  • Difficulty walking



Causes

Toe deformities can be congenital, present at birth, or can occur later in life from wearing improperly fitted shoes or high heeled shoes. Certain disease 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.



Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and physically inspecting the foot. This is followed by certain tests to rule out other nerve disorders that can cause weakened foot muscles.



Treatment Options

Non Operative Treatment

Toe deformities are usually flexible at first, but they harden into place over time. Treatment includes:

  • Regular stretching of the toe and toe joints
  • Wear soft comfortable shoes with a broader toe box and avoid tight and high-heeled shoes
  • Splinting or taping to hold or align the toes in the correct position.


Surgery

If non operative treatment is ineffective the doctor may suggest surgery where the main goal is to restore normal toe alignment and return to normal, pain free function. The surgical procedure is chosen based on the stability of the deformed toe, weather flexible or not.

If some flexibility exists, 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. 

In cases where the deformity is rigidly fixed, the surgeon will 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.


Find out more about Toe Surgery.

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