Toe / Digital Deformities

Toe deformities can arise through several different reasons including the way the foot functions (biomechanics), disease processes such as rheumatoid arthritis, neurological conditions, age (as we get older we are more likely to develop lesser toe deformities), trauma (capsulitis / plantar plate injury) and secondary to bunion deformities

There are many different types of digital deformities but the most common types are:

  • Hammered Toes
  • Clawed Toes
  • Mallet Toes

Hammered Toes

Hammer toe with large corn formation on the top of the joint

A hammer toe the middle part of the toe is positioned towards the ground. This causes pressure on the top of the toe where it kinks and often at the tip of the toe; these areas often develop a corn.

Clawed Toes

Clawed toes are a more complex deformity where the toe is sitting up in the air at the ball of the foot and cannot be reduced to a corrected position, the joints of the toe are also in a fixed position and point towards the ground. To correct this type of deformity surgery to the toe and often the metatarsal is required.

Mallet Toes

A mallet toe is where the tip of the toe is in a downward position, impacts the ground and produces a corn or thickening of the nail.

Overlapping 5th toe

Pre-surgery varus 5th toe.

This is often a congenital (born with) problem with the toe being elevated into the air and crossing over the 4th toe. Non-surgical management includes padding and footwear alteration, if this fails to alleviate the pain surgery may be required.

Post-operation varus 5th toe.

There are many other types of toe deformities including: cross over toes, conjoined toes and elevated toes. Management of toe deformities is tailored to the type.
Non-surgical methods of managing toe deformities include padding, strapping and footwear alteration.

Windswept Toes

Windswept toes can be managed through either soft tissue re-balancing, if the deformities are reducible or through removing a small wedge from the base of the toe.

Wind swept toes associated with a large bunion deformity. To correct the position of the toes the bunion would need to be reduced to allow for the toes to be realigned

Common Surgery Procedures

Surgery aims to realign the toes and the two most common procedures are:

ARTHROPLASTY

An arthroplasty (new joint formation) involves removing a piece of bone to reduce any contracture at the joint thereby allowing the toe to sit in a straighter position.

ARTHRODESIS

An arthrodesis involves removing the joint of the toe, realigning the bones and allowing them to fuse together in a corrected position. Fusion of the toe produces a rigid toe and reduces the risk of any recurrence and is indicated for certain digital deformities especially those associated with neuromuscular conditions.

To hold the bones together whilst they heal an internal fixation device sits between the two bones to stabilise the toes and allow for the bones to heal together thereby producing the fusion. The implant used in toe fusions is the smart toe, an internal fixation device, which allows for a more practical recovery as there are no wires protruding from the end of the toe, during the six weeks’ recovery time. The product can be viewed by clicking on the link beneath.