Lesser toe deformities are an important sub-speciality of foot surgery. The term summarises deformities of the second to fifth toe. Small toe deformities often occur in connection with a more complex deformity of the forefoot, which also includes the big toe. Small toes play an important role in the function and stability of the foot. They help to push off and balance the gait.
What are small toe deformities of the lesser toes?
Deformities of the little toes are not easy to define. They can be composed of deformities of several toe joints of the second to fifth little toe.
What are the different types of small toe deformities?
Foot surgeons diagnose and treat a range of different conditions based on small toe malpositions:
- the claw or claw toe
- the hammer toe
- the Digitus superductus
- the Mallet Toe
In the following, we explain how the individual clinical presentations manifest themselves and how they differ from each other. However, an exact diagnosis can only be made by an expert. Foot surgeon Dr Tonio Gottlieb will advise you highly individually on possible treatment options, always taking into account the entire static of the foot. So make an appointment right away!
What is a claw toe?
In the claw toe, there is a flexion deformity in the middle joint and the end joint of the affected little toe. The tip of the toe may still be in contact with the ground.
The foot surgeon speaks of a claw toe when the proximal phalanx of the toe in the metatarsophalangeal joint deviates upwards towards the dorsum of the foot, is almost or completely dislocated and the tip of the toe no longer reaches the ground. In the middle joint of this toe, there is usually a flexion deformity. Affected toes are usually strongly bent, the flexor and extensor muscles are tense.
What is a hammer toe?
If the metatarsophalangeal joint is hyperextended, the metatarsophalangeal joint is bent towards the sole of the foot and the distal joint is slightly extended towards the dorsum of the foot, the foot surgeon calls this a hammer toe. With this small toe deformity, the tip of the toe may be in contact with the ground.
What are the symptoms of digitus superductus (complex deformity of the forefoot)?
Digitus superductus consists of a combination of different malpositions, which can look like this: In the metatarsophalangeal joint there is a deviation towards the dorsum of the foot, the joint is partially or completely dislocated. The middle joint has a flexion deformity and the end joint is either also in a flexion deformity or is hyperextended. As a result of this overall complex malalignment of the forefoot, the affected little toe may also overlap an adjacent toe.
What is a mallet toe (hammer-like malpositioning of the end phalanx)?
In Mallet's toe, only the end joint of the big toe is affected. It has a flexion deformity, with the tip of the toe in or of contact with the ground.
Do you suffer from foot or toe pain? Do you have a known malposition of the toes? Then consult an experienced foot surgeon immediately.
As a specialist in foot surgery, Dr Tonio Gottlieb specialises exclusively in foot health, always keeping an eye on the body's entire statics. Dr. Gottlieb has been conducting research in his field for many years, which is another reason why he is always scientifically up to date. Make an appointment for an examination right away and benefit from Dr. Gottlieb's expertise.
How do small toe deformities develop?
There are many possible causes for small toe deformities. They usually arise due to static problems of the foot elsewhere. These include instabilities in the midfoot (e.g. hallux valgus), in the tarsus or in the hindfoot. But also tendon shortening or muscle weakness can lead to a disbalance between flexors and extensors at the level of the toes and thus cause malpositions.
If you wish, you can read more here or contact a foot surgeon who will advise you individually and recommend a specific course of action.
As already mentioned at the beginning, there are a number of causes that can lead to small toe deformities. For orientation, you will find the most important ones here:
- Disturbances in the statics of the foot, mostly in the area of the big toe (instabilities of this ray with and also without the formation of a hallux valgus) can lead to the remaining metatarsals, especially the second metatarsal, taking over the power transmission of the first and thus becoming overloaded. If the overloaded joint capsule under the metatarsal tears, this leads to the affected metatarsophalangeal joint no longer having any guidance. Without this guidance, all the responsible muscles guide the joint into a malposition. This mechanism is the most common cause of toe malpositioning.
- When the statics of the foot are disturbed, for example in the case of a flat foot, the toes try to stabilise it again. For this purpose, they use their long flexor muscles excessively. Over time, the flexor muscles become much stronger than the muscles that stretch the little toes. Slowly, this creates an imbalance of forces in the metatarsophalangeal joint.
- The long extensor muscles of the toes also extend the upper ankle joint. If the lifting of the foot in the ankle joint is now restricted for various reasons, the lower leg uses all other muscles that can fulfil this task. Thus, the long toe extensor muscle stretches all toe joints to the maximum in order to lift the foot. Its strength clearly exceeds the strength of the muscles flexing in the metatarsophalangeal joints. Therefore, the small toes in the metatarsophalangeal joint are stretched excessively upwards and at the same time the heads of the metatarsal bones are pressed into the ground. This toe malposition is often combined with a flexible hollow foot.
- If the calf muscles are weak, the toe muscles may try to compensate for this lack of strength. This creates an imbalance between strong flexor muscles at the base of the toes and weak extensor muscles of the toes.
Dr. Gottlieb recommends:
"Malpositions of the little toes can be very complex and the causes are manifold. Since they have an enormous influence on posture and body statics, an experienced podiatrist should be consulted who can give an exact diagnosis and, as a result, a stringent treatment recommendation.”
Hallux valgus (bunion) as a trigger of small toe deformities
The increasing crookedness of the big toe in the context of a hallux valgus can lead to the foot rolling over the outside of the foot or the neighbouring metatarsal bones. A small toe deformity such as hammer toe or claw toe can be the result.
What are the symptoms of small toe deformities?
A typical symptom of small toe deformities is the formation of calluses above the proximal interphalangeal joint and below the metatarsophalangeal joint. Above the proximal interphalangeal joint, calluses usually form due to inappropriate shoes; the foot surgeon also speaks of a shoe conflict. Calluses under the metatarsophalangeal joint are often the result of incorrect load transfer when walking. Other possible symptoms are
- Growth disorders of the toenails,
- a lack of contact of the toe tip with the ground and
- Pain in the affected toe and possibly also in the neighbouring toe.
At what point should a foot surgeon be consulted for a small toe deformity?
As soon as symptoms appear, it makes sense to seek the advice of an experienced foot surgeon. As a foot expert, Dr Tonio Gottlieb will advise you comprehensively on both surgical and conservative treatment options. His therapies are of international top quality. According to your indication, he will recommend the best therapy for you.
How can small toe deformities be treated?
Patients with small toe deformities have conservative and surgical treatment options. It is important to know that orthopaedic aids such as toe sleeves or shoe inserts are not promising in every stage of the disease. Correction of small toe deformities can often only be achieved through surgical intervention.
Diagnosis of small toe deformities
A qualified foot specialist diagnoses small toe deformities through a careful clinical examination. An X-ray examination of the foot while standing is essential to identify the causes of the deformity and thus to create a well-founded therapy plan. Dr. Gottlieb's particular focus is always on the entire foot: the visible symptom detection of malpositions of individual or several toes as well as the stability and mobility of the joints.
What is the therapy for small toe deformities?
At the conservative treatment level, it can be useful to adapt the footwear to the deformity. Support insoles that support the metatarsal head and soften the underside of the toes can help sufferers, as can intermediate toe pads, toe sleeves and toe reins.
If the deformity increases rapidly, is already severe and can no longer be treated conservatively, the foot surgeon has various surgical procedures at his disposal. The specialist takes into account whether the toe joints are already unstable, still flexible or possibly already stiffened. If you would like to learn more about surgical options, you are welcome to make an appointment for a consultation with Dr. Gottlieb. As a specialist in foot surgery, he can provide you with comprehensive information on the subject and answer your questions in detail.
Is surgery always necessary for small toe deformities?
In order to assess this, a consultation is first necessary. As an experienced foot specialist, Dr. Gottlieb can judge very precisely whether and when the optimal time for an operation to correct a small toe deformity has come.
Dr Tonio Gottlieb advises:
"Don't wait too long if you have complaints or notice clearly visible changes."
Does surgery make sense for a claw toe?
Since only an operation can fundamentally correct the deformity and this is usually associated with a good prognosis, it is sensible and recommended in many cases. Here, too, the foot surgeon decides in each individual case and depending on the diagnosis and gives the patient a clear recommendation.
When is surgery necessary for a hammer toe?
In the early or initial stages of hammertoe, no or only minor surgery may be necessary. In the advanced stage of hammertoes, therapies of all toes are usually necessary to achieve a good result.
At the latest when the malposition leads to pain and thus to a relieving posture that can throw the entire body statics out of balance, an operation or a visit to the practice of a qualified specialist in foot and ankle surgery is absolutely recommended.
What is the aftercare of surgery for small toe deformities?
Foot surgeons usually use tape bandages, wires and screws in their foot operations. Appropriate aids may be necessary for several weeks. If necessary, you will be given a bandage shoe or a special relief shoe for the forefoot. Dr. Gottlieb carries out regular wound checks and will remove the stitches after about two weeks.
Dr Tonio Gottlieb advises:
"Surgery to correct foot deformities or fractures of the foot or toes should only be performed by an experienced foot surgeon who has many years of surgical experience in this field.
Can small toe deformities be prevented?
If your small toe joints are still completely healthy, gymnastics for the feet and calves may help to prevent small toe deformities. If you have any anatomical abnormalities, you should have a consultation with the foot and ankle surgeon Dr. Tonio Gottlieb. After a comprehensive analysis of your entire body statics, he will advise you on sensible preventive measures.