Lesser Toe Deformities

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What are lesser toe deformities?

Lesser toes are all toes apart from the big toe. Lesser toe deformities can be due to deforming forces for example tight-fitting footwear, a deviated big toe (hallux valgus) or can be caused by soft tissue and joint instability from chronic inflammation (rheumatoid arthritis). Depending on the altered toe shape the resulting deformities are often called terms such as “hammer toe”, “claw toe” or “mallet toe”. These misshapen toes are not usually painful but can become so from footwear pressure or interference with each other. Diagnosis is confirmed by clinical examination.

What is the treatment?

Treatment is initially by footwear modification and/or the use of pads and spacers/toe seperators.Whilst these are widely available on the high street, assessment and advice form a chiropodist or podiatrist is often helpful.

When is surgery indicated n lesser toe deformities and what does it involve?

If non-operative treatment fails surgery becomes an option. This involves straightening the abnormal toes either by excising or stiffening (fusion) of the joints or dividing or re-routing tendons. Any of these procedures may include the insertion of metal pins that may need removal after 4-6 weeks. The removal is normally done in clinic and is generally tolerated well without an anaesthetic. Postoperative protection with a special shoe for 4-6 weeks is usually required. Lesser toe surgery is often performed in conjunction with other forefoot surgery such a s bunion correction.

What are the results of lesser toe surgery?

Surgically corrected lesser toes are often stiffer and less reactive to normal toes but the pain relief deriving from being straighter is usually satisfactory with the success rate in the region of 70-80%. The outcome is therefore a little less predictable than that of bunion surgery.