What is it?
A Lesser toe deformities may affect any of the two to five toes, and may occur on one foot or both. Lesser toe deformities are classified describing the position of the metatarsophalangeal (MTP) joint (where the toe meets the foot), and the interphalangeal (IP) joints (the two joints in the toe).
Claw Toe: The joint connecting the toe and the foot is hyperextended while both of the IP joints are plantarflexed.
Hammer Toe: The joint connecting the toe and the foot may be hyperextended and the first IP joint is plantarflexed.
Mallet Toe: The joint at the very end of the toe is plantarflexed in a fixed position.
Crossover Toe: Malalignment at the MTP joint in which the toe crosses over or under an adjacent toe. Most commonly affects the second toe, but may affect any of the lesser toes. (3)
Lesser Toe Deformity Joint Position, adapted from (4)
|Hammer Toe||Extended or neutral||Flexed||Extended, neutral or flexed|
|Mallet Toe||Always extended||Flexed||Always flexed|
|Cross-over Toe||Unstable||Neutral or flexed||Extended, neutral or flexed|
What do people experience?
Early symptoms can include:
- Joint stiffness
- Joint swelling
- Pain (primarily after activity, although with progression, pain can develop with ADLs)
Progressive manifestation of symptoms
- Fixed deformities
- Poor balance, resulting in an increased risk of falling
- Slower walking speed
- Atrophy of the soft tissues under the metatarsal heads
- Corns, callusing, blistering with friction on the top, ends or sides of toes as deformities become fixed
- Decreased joint range of motion
- Increased foot pressures under the forefoot
Risk factors for discomfort include:
- Poor fitting or worn out footwear
- Improper footwear for activity
- High impact exercise
- Heavy weight taining or intensity of exercise during periods of heightened symptoms
- Being overweight or obese may increase the pressure placed on your feet and the forces being transmitted through your joints
- Life stress and worry (anxiety) have been shown to worsen symptoms
What are my options for treatment? Who can help?
As a toe deformity develops, maintaining flexibility and range of motion in the joint is important. At this stage, conservative treatment options, including buddy taping the affected toe to an adjacent toe, may be beneficial, as well as a stretching program. As the deformity progresses (may become rigid in a fixed position), conservative treatment options focus on pain and symptom management. In severe cases, surgery may be considered for the affected joint.
Conservative treatment options include:
- Custom foot orthoses
- Stretching program
- Activity modifications
- Modalities including: toe loops, sleeves, spacers, or buddy-taping toes together
Staying active with a plan
Toe deformities may not be bothersome during activity for some, and for others they may hinder exercise. It is important that you maintain the available range of motion and flexibility within the joint, and choose accommodative footwear that does not irritate or cause undue pressure.
In some activities where you are barefoot (such as yoga, barre, or some dance classes), toe socks may help to reduce friction and pressures associated with deformity while allowing you to progress through movements.
Activity modification may be necessary if any movement produces particular discomfort.
1. Mickle KJ, Munro BJ, Lord SR, Menz HB, & Steele JR. (2011). Gait, balance and plantar pressures in older people with toe deformities. Gait and Posture, 34: 347-51.
2. Hannan MT, Menz HB, Jordan JM, Cupples A, Cheng C-H, & Hsu Y-H. (2013). High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care and Research, 65(9): 1515-21.
3. Doty JF & Coughlin MJ. (2014). Metatarsophalangeal joint instability of the lesser toes. The Journal of Foot and Ankle Surgery, 53: 440-45.
4. Shirzad K, Kiesau CD, DeOrio JK, & Parekh SG. (2011). Lesser Toe Deformities. Journal of the American Academy of Orthopaedic Surgeons, 19(8): 505-14.