Hammer toes, Clawed toes, Curly toes

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 Toe deformities are becoming more prevalent due to lifestyle and shoe characteristics. Though most people are quick to diagnose misshapen toes as ‘hammertoes’, there in fact are four different types of toe abnormalities. These include:

  • Hammer toes
  • Claw toes
  • Mallet toes
  • Retracted toes

Whilst there is an appreciable difference in the abnormal alignment of each type of deformity the causative factors and consequences are generally the same.

The hammertoe deformity is possibly the most common misalignment condition that affects the smaller toes. The condition is characterized by contraction of the toe to a position that can cause pressure spots to form due to shoe pressure whilst walking. Whilst the deformity itself is not life-threatening it can become worse and more painful altering the biomechanics of the feet in the process.

Lesser toe deformities are generally progressive and whilst they cannot be stopped, the speed of onset, progression of condition as well as symptoms caused can be controlled.

Causes

Lesser toe deformities are most often associated with a muscle/tendon imbalance in the feet. This imbalance causes the toe to bend and over time this bent position is adopted by the body as a ‘normal’ position. The adopted position can have a range of causes which can include but not be limited to:

  • Tight fitting shoes – forces toes into a cramped position
  • Structurally a longer second toe may adaptively be contracted to reduce its length
  • Joint instability
  • Osteoarthritis or other inflammatory joint conditions.
  • Genetic predisposition
  • A deviation of the big toe as seen with a bunion can cause the second toe to move into a structurally shorter position.
  • Trauma to the toe
  • Extensor (front leg) muscular tightness.

Signs and symptoms?

Many patients who present to podiatry clinics will usually complain of feeling pain or irritation on the surfaces of the affected toes and occasionally along the ball of the foot of the corresponding digits. Some of the more commonly reported symptoms can include:

  • Concern with alignment of the toes. Often report that the toes look ‘retracted’
  • Pain/irritation of the top or bottom of affected toes when wearing shoes
  • Corns or callouses which can build up on prominent areas of the feet.
  • Tender or sore skin as a result from excessive rubbing caused by shoes.
  • A struggle to properly and comfortably fit shoes.
  • A burning sensation underneath the balls of the feet often diagnosed as a plantar plate injury.
  • Altered walking patterns leading to compensation from other part of the lower limbs usually at the level of the ankle, knee or even hips.

Treatments

The treatments available for lesser toe deformities can range from non-invasive to surgical correction of the alignment. The non surgical interventions are aimed at controlling discomfort caused as well as controlling concomitant side effects while the surgical procedures involved generally aim to reduce and correct the misalignment and thereby improving function of the lesser toes.

Non-invasive

  • Debridal and removal of corns and callouses.
  • Padding of prominent or painful regions using felt or other soft material.
  • Wearing appropriate footwear including shoes with a deep and wide toe box.
  • Splinting and strapping toes to reduce the misalignment. This will only work if the deformity is not rigid in nature.
  • Orthotic devices to correct muscle imbalances
  • Physical therapies such as stretching ,massage or dry needling.
  • Ice and anti-inflammatory medication to reduce inflammation at exposed joints.
  • Injections to numb sore regions and provide temporary pain relief.

Surgical

Surgical correction is only reserved for those patients where most conservative treatments have failed to yield a satisfactory result or where the pain is debilitating. The surgeon usually will determine the procedure required to correct the abnormality. Some common methods of correction include tendon lengthening/cutting, reducing the length of the second metatarsal to bring it back into alignment with the remaining toes and toe joint arthroplasty. Like most surgical procedures, the correction will follow a number of weeks of rest and require the patient to wear a surgical boot prior to commencing physical therapies to strengthen the tendons and return the toes to regular function.

 

Dr Anel Kapur (Podiatrist)