Common Toe Deformities
Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate bio mechanics, 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.
Types of Toe Deformities
Toe deformities can be congenital, present at birth, or can occur later in life from wearing improperly fitted shoes or high heeled shoes. Certain diseases 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. If the toe becomes fractured, or the deformed toes become rigid and immovable, surgical treatment could be recommended. While surgery depends on the recommendation of your doctor, the main objective of the surgery is to restore normal toe alignment and return the foot to normal pain-free function. Conservative treatment may also be an option.
In mallet toe, the joint at the end of the toe buckles and the skin near the toenail tip develops a painful corn that can eventually result in an ulcer. The toe can become red and swollen and is often extremely painful. Because the second toe is typically the longest, it is the most likely to be affected by mallet toe. There are two types of existing mallet toe: flexible mallet toe and rigid mallet toe. Flexible mallet toes are in the developmental stage and the affected toes are still movable at the joint. Rigid mallet toes are more symptomatic. The tendons tighten and the joints become misaligned and fixed in this position.
In the case of Hammertoes, the toe has an abnormal bent at the middle joint leading to curling of the toe resembling a hammer. Hammer toe is commonly seen in the second toe, but can affect other toes as well. A hammertoe is usually caused by wearing shoes with high heels or narrow toe boxes. The affected toe may be painful or hard to move, and may develop corns or calluses. Another related condition called a bunion is often seen along with hammertoe, and involves a bony outgrowth along the side of the foot at the base of the big toe. Some cases require surgical intervention such as Lapidus Arthrodesis.
Claw toes are bent at the middle and end joints, and a dorsiflexion (a muscle that causes upward flexion) deformity at the metatarsal phalangeal joint. Corns or calluses may result from the pressure and rubbing on the bottom of the shoe or on the top of the toes. Symptoms of a claw toe include the upward bend of the toe(s) from the joint at the ball of the foot or the downward bend of the toe(s) at the middle joints toward the sole of your shoe. Sometimes your toes also bend downward at the top joints, curling under the foot. Corns may develop over the top of the toe or under the ball of the foot and can be extremely painful.
Retracted toes can best be described as abnormal flexion at both toe joints and extension at the metatarsal phalangeal joints. The ends of the toes do not contact the ground due to the extensor tendon on the top of the foot pulling them back. Retracted toes can increase the vertical pressure on the metatarsals resulting, in some cases, of pain from the sole of the foot.
What Causes Toe Deformities ?
An imbalance of foot muscles typically causes claw toes and hammertoes. Foot muscles become imbalanced due to some of the following factors:
- Wearing tight fitting shoes
- Rheumatoid or osteoarthritis
- Spinal cord tumors
Causes for retracted toes also include having flat feet, hereditary factors such as having a long second toe, and even bunions. Toe deformities can be congenital. Additionally, those with high arches, or those who tend to rotate their feet inward while walking, are susceptible to toe deformities.
Treatment Options for Toe Deformities
Nonsurgical treatment of toe deformities can be as simple as wearing proper-fitting shoes with soft soles or strengthening and stretching toe muscles through exercises. As for extreme toe deformities that require surgery, treatments include tendon lengthening and rerouting, shortening the bones of the phalanx, or possibly temporarily inserting a steel pin for correction. To learn more about orthopedic procedures of the toe, click here.
If you suffer from toe deformities or are currently experiencing similar symptoms, schedule an appointment with one of our fellowship trained foot and ankle surgeons, Dr. Adam Crawford or Dr. Donald Stewart, to find the treatment right for you.