A number of different deformities can affect the lesser toes (toes 2 to 5). The picture below demonstrates the three common variations: Hammer, claw and mallet toes.

What causes these deformities?

• Trauma – An injury to a lesser toe can result in a fracture, or damage to the soft tissues which can cause deformity.
• If you have a bunion or wear/tear (arthritis) in the big toe joint, this can result in more pressure being placed through the lesser toes. This weakens the lesser toe joints, which can result in deformity.
• Shoes that are too tight resulting in the toes being squashed.
• There are some patients who have tight calf muscles and subsequently use the tendons that straighten the toes, to compensate. This can pull the toes into one of the deformities above.
• Finally rare muscle and nerve disorders, such as Charcot-Marie-Tooth disease, result in muscle imbalances that cause the toes to deform quite severely.

Each deformity is slightly different and they are differentiated by the specific joints which are affected.

What are the symptoms?

Typically the deformed toe rubs on a shoe, and causes pain and hard calluses. Additionally, excessive pressure is placed under the metatarsal head of the corresponding deformed toe, which can cause a hard callus and this is sometimes called metatarsalgia.

How is the condition diagnosed?

Your foot will be examined and the diagnosis will be apparent from visual inspection. A detailed examination is mandatory to assess the flexibility and stability of the affected joints, as this will influence treatment. X-rays will be performed to diagnose any associated problems in the foot such as a slightly long metatarsal bone or a bunion, which can predispose to toe deformity.

What are my treatment options?

It is always prudent to try and accommodate the problem with wider and more comfortably fitting shoes. Insoles prescribed by a podiatrist, can help distribute pressures in the foot, and can sometimes help.

If the above measures fail, or are not acceptable to you, surgery can be considered. Operative treatment aims to change the alignment of your toes so they lie flat when you stand. Many different options are available and Mr Amin will discuss these with you in detail during your consultation.