A Guide to Toe Deformities
There are several medical conditions which can cause malformation of your toes. In the majority of cases these toe deformities are self-inflicted, albeit unwittingly. Toe deformities are most commonly caused by wearing footwear which does not fit properly, and restricts the movement of the toes. Poorly fitting footwear pushes the toes and joints out of a natural and neutral alignment and over time the feet adopt the shape of the shoes. Toes bend, angle inwards or upwards, and once the deformity has started it rarely corrects itself. In the absence of a single trauma, toe deformities develop over a period of time and get progressively worse until ultimately they require surgical correction. Correct the root cause of the problem early and your feet and toes will return to their former glory.
Any shoe with a narrow toe box such as fashionable pointed shoes can cause toe deformities to develop. With high heels and narrow shoes bunions and overlapping toes are the most common problems. Short toe boxes which cause the toes to bunch up and curl around can lead to hammer toes, mallet toes, and claw toe deformities. The toes start to retain the position after removing shoes, and whilst they can be straightened manually at first, over time they lose flexibility and remain rigid and cannot be straightened even with manual manipulation.
Toe deformities may or may not cause pain, and the severity of the condition will vary from individual to individual. At first a change of footwear may be all that is required to treat the condition however as time passes correction will require surgery. There are 7 main toe deformities, with each most commonly affecting women rather than men due to footwear choice.
Big Toe Deformities
The big toe consists of two bones, whereas the lesser toes each have three. The bones are called phalanges (singular = phalanx) with the deformities starting at the joint between two bones. With the big toe it is the first joint which is the most problematic, where the first phalanx of the big toe joins with the first metatarsal of the foot.
The most common big toe deformity is a bunion, and due to the relatively large bones (by foot standards) it can produce a considerable deformity. A bunion is the name given to a hard and bony lump which forms on the inside edge of the foot at the first joint of the big toe; termed the metatarsaophalangeal joint. A bunion is actually a dislocation of the metatarsal head, with it moving outwards often accompanied by the laying down of new bone cells (osteophytes).
The big toe also angles outwards and starts to point at the other toes. Over time the bump grows in size considerably and the angle of the toe becomes more pronounced. A bunion forms usually due to excess pressure from footwear, with a narrow toe box the main culprit, made worse by an elevated heel. A high heel increases the pressure on the balls of the foot speeding up bunion formation considerably. As the lump grows, the pressure from footwear also increases in a runaway process. The bunion can become red, inflamed and sore due to pressure and friction, and the skin may become broken, leading to infection. Read more about Bunions
Trigger toe is a name given to two big toe irregularities. The first affects the interphalangeal joint – the joint between the two phalanges in the big toe. Pressure on the toe or tightness in the tendons and ligaments can lead to this condition developing. It is often linked to neuromuscular irregularities, arthritis and abnormally high foot arches. As the name suggests, it causes the big toe to take on a trigger shape, becoming permanently bent.
The condition starts slowly and forms over a period of time, with the toe losing flexibility as the condition deteriorates. The toe remains flexible at first, but becomes more rigid over time until no movement is possible. The condition can lead to inflammation of the bursa (joint capsule), and the deformity can place greater pressure on other parts of the foot, in particular the sesamoid bones, triggering a painful condition called sesamoiditis. The bend in the toe can push the top of the joint into footwear with blisters, corns and callused skin forming as a result of friction.
Trigger toe is also the name give to the foot equivalent of trigger finger, where the flexor tendon which controls movement of the toe sticks in the tendon sheath; a tunnel through which the flexor tendon passes. The flexor tendons start in the lower leg and run through the ankle to the toe, passing through a “tunnel” at each joint called the tendon sheath. When the tendon becomes irritated at this point it can thicken, or nodules can form which limit its passage through these tendon sheath tunnels. As a result, when the toe is bent it cannot easily be straightened and catches at this point. In mild cases, the toe can be straightened, although in severe cases it remains in a contracted “trigger” state. Read more about trigger toe
Lesser Toe Deformities
The smaller toes are not without their problems, and have a greater range of deformities due to there being three bones and joints in each toe. The extra bone and joint adds a new location for a deformity to occur. Each toe deformity can be classified by the joint or joints which it affects, although the outward appearance and the deformity itself may look very similar to the untrained eye.
A hammer toe is the most well known and common lesser toe deformities, although it is often incorrectly used as an umbrella term for any toe deformity affecting the lesser toes. It most commonly affects the second toe, with that being the longest of the lesser toes and hence the toe most frequently subjected to pressure from footwear.
A hammer toe is a toe deformity affecting the first interphalangeal joint in the middle of the toe. A hammer toe involves the partial or complete dislocation of this joint, causing the toe to lift upwards in the middle and the end of the toe curls around and adopts a claw-like or hammer-like appearance. The ligaments and tendons in the toe will shorten over time, and the deformity will become permanent. At first the toe can easily be straightened, but as time passes it becomes more rigid until it cannot be straightened even with manipulation. Since the middle of the toe is raised, it can rub against shoes and calluses can form on top of the toe, and in some cases also on the sole of the foot. Foot corns are common with this toe deformity, which can become painful due to the pressure exerted. Toe joint pain may also be experienced. Read more about hammertoes
A mallet toe is essentially a hammer toe where the bending takes place at the last joint of the toe, termed the distal interphalangeal joint. This deformity sees the toe take on the shape of a mallet, with the end of the toe permanently bent. As with a hammer toe deformity, in the initial stages the toe can still bend with manipulation although it will become more rigid over time with the ligaments tightening. Corns and callused skin is likely to form on top of the last joint in the toe. This condition is most common in the second toe, but can occur in any of the lesser toes, and sometimes in all of them. When this occurs balance can be affected. Read more about mallet toes
A claw toe is probably the most pronounced of the lesser toe deformities and is essentially a hammer toe and a mallet toe occurring on the same toe, with a permanent bend at both interphalangeal joints. Once the deformity has started, it will rarely correct itself even with a change of footwear. The claw toe, as the name suggests, will give the toe a distinctive claw or talon-like appearance, which may also see it start to curl underneath the foot. It can make walking painful and difficult and can affect the balance. It is frequently caused by improper shoes which cramp the toes, but can also occur due to tendon or ligament weakness, diabetes, strokes and arthritis. It is often accompanied by corns on the toes and the ball of the foot, with callused skin forming underneath as the weight distribution changes. Read more about claw toe
A bunionette is a bunion which occurs on the first joint of the little toe. It is characterized by a lump forming on the outside of the foot. The lump is smaller than a big toe bunion as the metatarsal head which protrudes outwards is smaller. The bunionette is also known as a tailor’s bunion, being common with tailors sitting cross-legged on hard floors for hours on end. The pressure often caused these lumps to form on both feet. The reasons for bunionette formation is the same as the equivalent condition on the big toe, with pressure from footwear the commonest cause.
Whilst a change of footwear can see the condition reversed in the early stages, a bunionectomy ill be required if it is allowed to progress. The problem with this type of surgery is that due to the small size of the bones, toe movement is more likely to be lost following surgery than with a bunionectomy performed on the big toe. With bunionette removal, the toe may have to be pinned permanently in place and will remain rigid.
Overlapping toes are linked to hammer toes, bunions and bunionettes, and frequently occur with the big toe and second toe overlapping, or the fourth and fifth toe crossing. The condition is almost always caused by poor footwear choice, resulting in the foot adopting the shape of pointed shoes. The condition can affect the balance, and can lead to other foot deformities developing. Corns and calluses are commonplace due to changes in pressure due to the overlapping toes.
Foot lotions are beneficial for keeping the skin supple to prevent callused skin forming, with toe straighteners helpful to restore the toes to their natural position. A change of footwear to shoes with a wide and roomy toe box is recommended, with sandals often being the best choice. Orthotic insoles can help to correct foot function, although surgical correction may be required to fully restore alignment of the feet. Read more about overlapping toes