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Lesser Toe Deformities


A hammertoe is a deformity in which the knuckle of the toe (the PIP joint) becomes bent and stiff causing a potential painful prominence. It is a progressive condition in which the deformity increases over time at varying rates. The prominence can become so large it rubs against the top of the shoe causing pain. Patients with this condition often experience pain, swelling, redness and stiffness in the affected toes.

Causes of Hammertoes

While most cases of hammertoes are caused by an underlying muscle imbalance, it may develop as a result of several different causes, including arthritis, a hereditary condition, an injury, or ill-fitting shoes. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted, causing an abnormal “v”-shaped bending of the little toes. In some cases, patients develop hammertoes after wearing shoes or stockings that are too tight for long periods of time. These patients usually develop hammertoes in both feet.


Conservative treatment consists of using shoes that accommodate the deformity and possibly using tape or budin splint to hold the toe down. These treatments do not cure the bent nature of the toe nor prevent progression but can help with pain from the rubbing. When conservative treatment fails to give enough relief of pain or there is too much trouble with shoes, surgery is recommended.

Surgery involves removing a small section of bone from the affected joint through a procedure called arthroplasty. Arthrodesis may also be performed to treat hammertoes, which involves fusing together one of the joints in the toe in order to keep it straight. This procedure requires the use of a metal pin to hold the toe in position while it heals.

It is best known to wait too long has very severe deformities can be more difficult to correct, particularly if there is too much bending up at the base of the hammertoe toe where the toe meets the foot (the MP joint).

Mallet Toe

A mallet toe Is when the toe is bent down at the joint at the tip of the toe ( the DIP joint). Call though it creates a bony prominence usual problem is pain at the underside of the tip of the toe from the tip hitting the ground too hard. Treatment for the pain is to lift the toe up somewhat as can be done by using a toe crest. When conservative treatment fails, surgery can be done by trimming the bone at the joint and straightening the toe.

Medial Crossover Toe

This condition occurs when the second toe moves over and eventually over the top of the big toe.

It most often has a hammer toe coating with the knuckle but the crossover component causes a much more difficult problem to treat.

Again, surgery is only recommended when the toe hurts from rubbing against top shoe or so rubbing against the great toe. If a hammer toe is being corrected and it has medial deviation at the base of the toe treated surgery is recommended at the base of the toe to discourage the formation of a medial crossover toe. Conservative treatment of the deformity can be done by taping the toe to a corrected position. This can minimize symptoms but does not stop the progression of the deformity.

When the deformity is severe, it is difficult to treat even surgically. It is therefore recommended to do surgery when causing symptoms but also when it has not become a severe deformity, completely crossed over the big toe. Surgery consists of treating the hammertoe component and also realigning the joint at the base of the toe. This can be achieved by releasing contracted tissue but can also require rebuilding of the ligament on the outside of the toe to pull it straight, which can sometimes require shortening second metatarsal bone to allow correction of the deformity. Again, it is important to do the surgery before the severe deformity as severe deformity even with these measures could not allow enough correction. In older patients because the second toe when it is completely crossed over is not functional amputation is an option to relieve pain give a quick recovery.

Lateral or Medial Deviating Toes

Lateral deviating toes (valgus toes) and medial deviating toes (varus toes) occur when the second third and sometimes fourth toes migrate medially toward the little toe or medially toward the great toe. This unfortunately is usually a progressive condition and can cause discomfort or pain at the base of your toes and difficulty withe shoe wear. The conservative treatment is accommodative shoes and taping the symptomatic toes which is symptomatic but not curative treatment.

Decision to do surgery is made when the problem is becoming symptomatic, and progression of the deformity is recognized. Surgical treatment depends upon the severity of the deformity and consists of releasing contracted ligaments. It may be necessary to rebuild the ligaments that are loose and in the most severe cases correct the position of the metatarsal bone with an osteotomy.

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