LESSER TOE DEFORMITIES



Deformities of the toes

In everyday clinical medical practice meet people with deformities of the toes which except of the aesthetic disadvantage most often generate functional problems of the lower limb afflecting negatively the patients sentiment. 
The deformities of the fingers may relate to one or all joints of the toes of the foot.
A variety of the lesser toe (toes with two to five) deformities such as the hammer toe, claw toe, crossover toe and mallet toe may be associated with pain and footwear restriction.
Deformities of the lesser toes may involve the metatarsophalangeal (MTP) or interphalangeal (IP) joint or both and may involve single or multiple digits.

The term claw toe refers to the deformation of all the joints of the finger. The finger takes 'hook' shape and makes difficult for the patient to wear shoes of his choice.


Claw toe deformity.  The metatarsophalangeal joint in extension and proximal and distal interphalangeal joint are in flexion

Hammer toe deformity characterized by flexion of the proximal interphalangeal joint. With weight bearing the metatarsophalangeal joint appera dorsiflexed however, this should correct with elevation of the foot off the ground.

A mallet toe consist of an isolated flexion deformity at the distal interphalangeal joint.


Hammer toe deformity


Painfull press point on the 2nd toe
 

  • They occur throughout life, although are most often seen in the seventh and eighth decades.
  • Women are affected four to five times more often than men.

CAUSE

The deformities of the toes may be due to several factors.

  • In  pes cavus (high arch than normal)
  • Genetic factors
  • Poorly fitted shoes - usually the result of wearing shoes that are too short. (Many people have second toes that are longer than their big toes. If they wear shoes sized to fit the big toe, the second toe has to bend to fit into the shoe - causing mallet toe. High-heeled shoes with pointed toes are also a major cause of claw toes.)
  • The rheumatoid or psoriatic arthritis sometimes creates serious deformation of the fingers.
  • Neurological diseases - Charcot-Marie- Tooth syndrome, cerebral palsy which create imbalance of the forces exerted by the tendons in the fingers.
  • Trauma of the foot.

SYMPTOMS

Pain of the toes due to inflammation of the joints (rhematoid arthritis), or the callus formation and nail dystrophy. 

The person finds it difficult to wear the shoes, and thus starts to restrict the mobility. This results in the patient becoming overweight thereby exacerbating this problem

This set of things creates psychological problems in the patient leading him to further reduce physical activity.

CLINICALL EXAMINATION

The specialist in surgery of the foot and ankle Orthopaedic surgeon will evaluate clinically the feet, identifying thus the reason for the existence of claw toe, hammertoes, the stiffness of the deformation, the chronicity of this and the coexistence of other problems in the foot (bunions, hallux valgus, pes cavus)

They should also assess the general health of the person that is the investigation of diseases which may be the cause of the occurrence of deformities (psoriasis and psoriatic arthritis, neurological problems, etc).

The evaluation of the patient's gait problems in the fingers is necessary as well as the clinical monitoring of other joints can be affected by the condition of the legs (knees).

X-RAYS AND LAB TEST

  • The radiological examination -X-ray- of the feet is the basic examination.
    The blood tests for the investigation of autoimmune diseases (rheumatoid arthritis), and the control of blood glucose for diabetes is necessary.
    The evaluation of vascular condition -triplex-, of the lower limb, will help to Orthopaedic surgeon about the skin's ability to heal after the operation.

 

CONSERVATIVE TREATMENT
THERAPY: 

Conservative treatment is aimed at preventing a worsening of deformities and pain management.

  • The foot care specialist for cleaning and care of corns and callus formations.

  • Wearing supportive custom-made plastic or leather shoe inserts (orthotics) to help relieve pressure on toe deformities.
  • Using splints or small straps to realign the affected toe.
  • Wearing shoes with a wider toe box.
  • Injecting anti-inflammatories to relieve pain and inflammation.


Toes splint


Small straps to realign the toes


Special pads for the corns
 

OPERATIVE TREATMENT
THERAPY: 

Surgical treatment is applied in cases of deformation of the fingers which are painful to achieve correction of the mechanical axes of the toes giving thereby stably and functional toes.

The type of surgery depends on whether the deformations are flexible or rigid and include manipulation of soft tissues - section of the tendons, tendon transfer or bone as osteotomies or arthrodesis.

Surgical treatment is the final solution in cases where the cause of the deformations are rheumatoid arthritis and generally in autoimmune conditions involving and joints of the fingers.

Plastic of the extensor tendons of the toe
 

Metatarsal head osteotomy and stabilization with special titanium screw. The surgery helps to correct the mechanical axis of the toes


Radiographic examination during surgery for checking the correct placement of titanium screws in the bones and control the correction of deformities of the toes


Post-op X-ray


Woman 73 years old with severe toes deformity pre - op     


Post-op


Pre-op


Post-op