19 Mar Toe Deformities
Toe deformities are one of the most common of all foot-related conditions. They occur due to abnormal positioning of the foot bones, maladjusted biomechanics, and several diseases such as arthritis or trauma. Toe deformities affect the alignment of the bones, joints and the soft tissues in the foot, and also affect other related weight-bearing joints, such as the hip and the knee. The three most common toe deformities are hammertoes, claw toes, and mallet toes.
These deformities can have multiple causes – they can be either congenital or occur due to injury, degenerative, inflammatory events. Diseases that are implicated in the development of toe deformities include diabetes, stroke, osteoarthritis, rheumatoid arthritis, etc. Most of these toe deformities elicit similar symptoms – pain during wearing shoes is the classic feature. Most of these patients wear improperly fitting shoes, which cause calluses and hard skin outgrowths. Initially, the deformed toe is usually flexible but if left untreated, it gets rigid and immobile, ultimately requiring surgical treatment.
Hammer toes are bent at the middle joint leading to curling of the toe (typically 2nd) that resembles a hammer. A bunion is often seen along with hammertoe, which is a bony outgrowth along the side of the foot at the base of the big toe. Mallet toe is similar to hammer toe but involving the upper joint instead of the middle joint, giving the toe a mallet-like appearance at the end of the toe. Claw toes bend upward at the ball of the foot and then downward in a claw-like fashion, at the middle joint and sometimes end joint. Claw toe can occur in any toe from 2nd to 5th.
All of these conditions are clinically diagnosed based on physical appearance on inspection, but if nerve involvement is suspected, imaging can be performed. Treatment is mainly conservative with a focus to restore or maintain walking ability, relieve pain, and also to delay the progression of the deformity. This includes wearing specially designed shoes with cushions or pads with more room for the toe deformity. Surgical treatment is needed if conservative treatment fails and/or deformed toes become rigid and more painful, with the goals of restoring normal toe alignment and pain-free function.
If there is some flexibility in the toe, then the surgery involves realigning the tendons and ligaments, placing pins to keep the toe in position while healing. However, if the toe is not flexible, surgery involves realigning the tendons and ligaments and an osteotomy, followed by inserting pins to keep the toes aligned while healing. Sometimes, the surgical procedure leads to incomplete correction of the deformity resulting in worsened stiffness of the toe. Very rarely, there may be post-surgical avascular necrosis or damage to the nerves. Recovery takes around 2-6 weeks and requires wearing special boots to prevent bending the operated toe.