Common Toe Deformities
The toes are the digits in your foot and are associated with walking, providing balance, weight-bearing, and other activities. A variety of toe deformities can occur in the feet. They include:
- Hallux Valgus: Hallux valgus is a common toe deformity in which the great toe is shifted laterally and lies over the second toe. The first metatarsal bone is deviated towards the medial side, causing a prominence over the medial aspect of the metatarsophalangeal (MTP) joint. A fluid-filled sac (bursa) may form over this prominence which may result in a painful bunion caused by continuous irritation and inflammation. Foot pronation (flat feet) may sometimes be associated with this condition. The factors that cause hallux valgus include structural foot anomalies that may or may not be hereditary and the use of narrow shoes that curl or fold the toes. Patients having hallux valgus may not have any symptoms most of the time and usually do not require any treatment. Your doctor may advise wearing shoes that have good amount of space for the toes. If there is flat foot (pes planus), then a shoe insert may help to prevent its progression. Surgery may be recommended in severe cases.
- Hammer Toe: Hammer toe is a deformity in which there is downward bending of the middle joint of the toe, known as the proximal interphalangeal (PIP) joint. Although it can affect the other toes, it most commonly affects the second toe. It may be present at birth or may result from wearing shoes that are too tight which forces the toe to bend forward. It causes no pain and does not require any specific treatment. Hammer toe can be treated by wearing well-fitting shoes that have enough space for the toes to stretch.
- Mallet Toe: Mallet toe refers to the downward bending of the third joint of the toe, known as the distal interphalangeal (DIP) joint. This gives the toe a mallet-like appearance. Corns or calluses may develop over the deformity as a result of constant friction against the footwear. Mallet toe can be inherited or may develop from wearing shoes that are too tight or high-heeled.
- Claw Toe: Claw toe is a rare deformity that occurs in association with cavus foot, Charcot-Marie-Tooth disease, or myelomeningocele. It affects all the toe joints and results from hyperextension of the metatarsophalengeal (MTP) joint (1st joint) and flexion at the PIP (2nd joint) and DIP (3rd joint) joints. It results from altered structural anatomy and/or a neurologic disorder that causes muscle imbalance.
- Curly Toe: Curly toes are present at birth and affect the third, fourth, and fifth toes of one or both feet. It is caused by tightening of the tendon that runs below the toe which results in pulling of the tip of the toe under the next toe towards the sole. Patients may develop areas of hard skin on the sole of the foot and may have difficulty in selecting suitable shoes that fit properly.Generally, no treatment is needed if curly toes do not cause any symptoms but, if the condition becomes severe and causes irritation, surgery may be performed to release and transfer the toe flexor tendon.
- Polydactyly: Polydactyly is a condition in which there is an extra digit present in the foot. The great toe or the fifth toe is usually affected. It may occur in association with other congenital anomalies or as an isolated problem. If the extra digit does not cause any problems, it may be left alone without any treatment. Surgical excision of the extra digit will be done in cases where there is an extra prominent little or big toe that causes difficulty in wearing shoes. Surgery is usually done after the age of 9-12 months.
- Syndactyly: Syndactyly is the presence of fused digits and may occur along with other congenital anomalies or as an isolated problem. It rarely causes any problems and does not need any treatment. The connection between two or more toes varies from a thin skin attachment to a bony attachment (synostosis) between the phalanges.
- Bunionette (Tailor Bunion): A bunionette is an uncommon condition that occurs at the fifth MTP joint. When it occurs, the fluid sac over the lateral side of the fifth MTP joint becomes prominent and inflamed, causing pain. Padding is used to relieve the discomfort. If this does not help, surgical correction will be needed.