What is a toe deformity?
There are various types of lesser toe deformity and depending on the shape, we call these hammer, clawed or retracted toes.
In the average person, there are three small bones (phalanges) in each of your four small (lesser) toes on each foot. These bones are connected by ligaments and have small muscles and tendons within the foot that control their movement and stabilise them against the ground when you walk. The larger muscles and tendons within the leg move these toes. Toe deformities can occur when there is an imbalance with the muscles within the foot and the leg. External pressures from shoes and direct injury can cause buckling of the toes that can result in toe deformity. Certain inflammatory and neurological conditions can cause toe deformity as well.
What causes the problem?
Like bunions, there is no single cause of lesser (small) toe deformities. They are most often caused by a defective mechanical structure of the foot which can be caused by genetics; certain foot types make a person prone to development of toe deformities.
Altered position of your lesser toes commonly results in pressure from shoes or the next toe which results in painful hard skin forming. It is very common to see corns and calluses around the tips of toes or on the small toe joints.
Poorly fitting footwear tends to aggravate the problem as it can squeeze the forefoot, crowding the toes together and exacerbating the underlying condition, causing pain and deformity of the joint. With advancing age, toe deformities may progress. Associated medical conditions like arthritis can alter the shape and position of your toes, as can trauma.
Is it serious?
Some people have significant toe deformities that are painless but cause difficulties with footwear, while others have relatively subtle toe deformities that can be very painful. Although some treatments can ease the pain, only surgery can correct the deformity.
In some cases, pressure from the surrounding toes can lead to a domino effect which results in further toe deformities and/or pain in the metatarsals (long bones in the forefoot). An example of this is when deformities of the small toes are made worse by progressive bunion deformities.
People who have altered nerve supply or blood supply to their feet and are deemed to be at risk of lower limb loss often first present with ulcers on their smaller toes. If left untreated, these seemingly small issues can progress rapidly to limb threatening problems.
Who gets it?
Anyone can have a foot structure that means they are prone to problems with their smaller toes, but they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn. If your parents or grandparents have toe deformities, you may also be more prone to developing them. People who have medical conditions such as diabetes or inflammatory arthritis may also develop severe toe deformities as the disease progresses.
How do I prevent toe deformities?
Wearing sensible shoes that fit well is a good preventative measure. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:
- If you want to wear heels, vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels
- Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk
- Wearing a shoe with a strap or lace over the instep holds the foot secure and stable reducing the need for you to try to stabilise your foot with your toes
- If you already have toe deformities, try to accommodate your toes by selecting shoes with a wider/deeper toebox
Your podiatrist may recommend the following:
- No treatment (you can elect to live with your toe problems)
- Regular review by a podiatrist who will reduce the callus build-up periodically
- Advice on foot cream and topical medication for associated problems
- Splints, shields, off-loading devices and shoe alterations/footwear advice
- An opinion from a podiatric surgeon
Non-surgical treatments may help relieve symptoms but there is no evidence that they can correct the underlying deformity. Your podiatric surgeon will evaluate the extent of the deformity. They can remodel the shape of your toes so they have a greater chance of fitting inside the average shoe.
Deformities of the small toes can occur in any one of the three joints in each toe and in any direction so surgery is complex and, due to the size of the bones and joints, intricate. There are lots of surgical options for toe deformities and an increasing number of new technologies in surgery for small joints.
The aim of surgery is to address the underlying deformity to prevent recurrence. As with all surgery, there are risks and complications, so it is important to balance any potential risk against any perceived reward when you are considering foot surgery. You should certainly consider getting an opinion about surgery or surgical options from a podiatric surgeon if you are in pain or experiencing progressing deformity.
When should I see a podiatric surgeon about it?
If you experience any foot care issues which do not resolve themselves naturally or through routine foot care, then you should make an appointment with a podiatric surgeon.
Your podiatric surgeon will discuss your options in a shared decision-making process taking into account your presenting symptoms, your age, activity level, occupation and medical history, and will request appropriate imaging. Your podiatric surgeon will help you to make an informed decision as to what is best for you.
Podiatrists and podiatric surgeons are registered with the Health and Care Professions Council (HCPC). You can check your professional is registered here.