The foot’s anatomy is divided into three sections: the forefoot, midfoot, and hindfoot. The forefoot consists of the big toe (hallux) and the four smaller toes known as phalanges. The phalanges are composed of three bones and three joints, while the big toe has only two bones and two joints. The midfoot and hindfoot have distinct structures and are responsible for walking, running, and supporting weight.

Toe deformities are common and can arise from various causes, such as abnormal positioning, bone and joint diseases, tissue problems, and biomechanical issues. These deformities not only affect the alignment of bones, joints, and tissues in the foot but can also impact the joints in the hips and knees due to misalignment in weight-bearing joints. Some examples of common toe deformities are hammertoes, mallet toes, and claw toes.

Causes of Toe Deformities

Toe deformities can have different causes. Some are congenital, meaning they are present at birth, while others develop over time due to environmental factors like wearing ill-fitting shoes. Certain diseases can contribute to toe deformities by causing tightness in ligaments and tendons. Conditions such as diabetes, stroke, rheumatoid arthritis, and osteoarthritis can affect muscle and nerve function, resulting in toe deformities.

Accidents and injuries can also lead to toe deformities. Fractures in the toes can have a lasting impact on their overall health and increase the likelihood of developing deformities.

Signs and Symptoms of Toe Deformities

Toe deformities like hammer toe, claw toe, and mallet toe share similar symptoms. These include experiencing pain while wearing shoes and struggling to find comfortable and properly fitting footwear. Ill-fitting shoes can exert pressure and cause friction, leading to the development of calluses and corns over time.

In the initial stages, these deformities often allow some flexibility in the affected toe. However, if left untreated, the joint can gradually become rigid and immobile. In such cases, surgical intervention may be required. Seeking medical attention early on can help prevent the condition from progressing to this extent.

Toe Deformity Characteristics

Hammertoes: Hammertoes are characterized by a bend in the middle joint that gives the appearance of the toe curling, resembling a hammer. While the second toe is most commonly affected, other toes can also be impacted. Hammertoes are often associated with bunions, which are bony outgrowths along the side of the foot near the big toe.

Claw toes: Claw toes can be identified by the upward bending of the toe joint near the ball of the foot, followed by a downward bend resembling a claw. The toes typically bend downward at the middle joint, but it can also occur at the end joint. Claw toe can affect any of the four smaller toes, excluding the big toe.

Mallet Toe: Mallet toe is similar to hammertoe, but the bend occurs at the upper joint instead of the middle joint. The toes appear as though a mallet is attached to the end of the toe.

Diagnosis

Diagnosing toe deformities typically involves a physical examination by a healthcare professional. In most cases, these conditions can be diagnosed based on the physical appearance and range of motion of the toes. Diagnostic tests are usually not necessary for these conditions.

However, if there is suspicion of nerve involvement or other underlying complications, specialized testing may be recommended. These tests could include nerve conduction studies, electromyography (EMG), or imaging studies such as X-rays or MRI scans to evaluate the structures and determine the extent of the deformity. These additional tests are typically performed when there are specific concerns or when the diagnosis is not straightforward based on the physical examination alone.

Treatment

After an initial diagnosis of a toe deformity, the treatment approach is often conservative, focusing on restoring or maintaining the ability to walk, slowing the progression of the deformity, and alleviating pain.

Conservative treatment methods typically involve:

• Specialized shoes: Wearing shoes with pads and cushioning, particularly in the enlarged toe box area, helps protect the skin from pressure and friction that can lead to skin breakdown. It is important to avoid tight or narrow-toed shoes and high-heeled footwear.
• Tape and splints: To reposition the toes and relieve discomfort, tape and splints can be utilized. These techniques help straighten and realign the toes to a more natural position.
• Toe stretching exercises: Specific exercises may be recommended to stretch and strengthen the muscles and tendons in the toes. These exercises can help improve flexibility and alleviate stiffness or discomfort.

The aim of these conservative measures is to manage symptoms, prevent further progression of the deformity, and improve overall foot function. However, it’s important to note that the specific treatment plan may vary depending on the type and severity of the toe deformity, and individualized recommendations from a healthcare professional are crucial.

When conservative treatments fail to provide sufficient relief or when the toe deformity is rigid and immovable at the time of diagnosis, surgical treatment is often recommended. The goal of surgery is to restore the natural alignment of the toe and enable the foot to regain normal function without pain.

The specific surgical procedure performed depends on the flexibility and stability of the deformed toe. If the toe still retains some degree of flexibility, an incision may be made over the affected toe to allow for the repositioning of tendons and ligaments. Pins may be inserted to maintain the corrected position of the toe while it heals.

In cases where the deformity is rigidly fixed, the incision is typically made over the affected joint. The tendons and ligaments are realigned, and if necessary, an osteotomy may be performed. An osteotomy involves the removal of bone fragments to achieve proper alignment. Pins are then inserted to stabilize the toe and maintain its alignment during the healing process.

The choice of surgical technique is based on the individual’s specific condition and the assessment of the healthcare professional. The ultimate objective is to correct the deformity, relieve pain, and restore normal function to the foot. Postoperative care, such as physical therapy and follow-up visits, will be essential for a successful recovery.

Risks and complications

Indeed, as with any surgical procedure, there are inherent risks and potential complications involved. In addition to the general risks associated with surgery, there are specific risks related to toe deformity correction surgeries. 

Some of these risks include:

Stiffness of the toe. Following surgery, there is a possibility that the toe may become stiff and have a reduced range of motion. Physical therapy and rehabilitation exercises are often recommended to minimize stiffness and promote flexibility. Inadequate correction of the deformity. Despite surgical efforts, there is a chance that the correction may not be fully achieved, and some degree of deformity may persist. This can occur due to various factors, such as the severity of the deformity or limitations during surgery. Loss of blood supply to the toe. In rare cases, there may be a risk of compromised blood flow to the toe, leading to tissue damage or necrosis. Surgeons take precautions to minimize this risk, such as carefully handling blood vessels and monitoring blood circulation during and after the procedure. Potential nerve damage. The surgical intervention near the toe carries a slight risk of nerve injury. This can result in temporary or, in rare cases, permanent numbness, tingling, or altered sensation in the surrounding area.

It is important for patients to have a thorough discussion with their healthcare provider regarding the potential risks and complications associated with toe deformity correction surgery. This allows them to make an informed decision and understand the measures taken to minimize these risks during the surgical procedure.

Post-operative care

Following your toe deformity correction surgery, the surgeon will provide you with specific guidelines for your post-operative care. These instructions will include a recommendation to wear a post-operative shoe for a period of 2 to 6 weeks. Wearing the post-op shoe is crucial as it allows your toe to heal properly during this crucial recovery phase. The post-operative shoe is specially designed to provide support and protection to your foot, minimizing strain on the surgical area. It is important to follow the surgeon’s advice regarding the duration of wearing the post-op shoe to ensure optimal healing and reduce the risk of complications. Remember to follow all other post-operative care instructions, such as keeping the surgical site clean, taking prescribed medications, and attending follow-up appointments as scheduled.

Surgery to correct toe deformities can often be prevented with proper care. At Flint Foot and Ankle, our team is dedicated to assisting you in determining the best treatment options and creating a personalized treatment plan tailored to your specific needs. Whether you currently have a toe deformity or suspect that you may have one, we are here to provide the necessary support and guidance.