Lesser toe deformities should be treated early: Literature review

While deformities of the lesser toes (all toes other than the big toe) can be very painful, there are numerous surgical and nonsurgical treatments for these conditions that are usually quite effective. A literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) shows that because lesser toe deformities are often treatable, and can be symptoms of other conditions, early assessment and treatment by an orthopaedic surgeon is important.

"Toe pain can limit a person's quality of life," says Khalid Shirzad, MD, an orthopaedic surgeon at Northwest Orthopaedic Specialists, P.S., Spokane, Wash., and lead author of the review. "When it hurts to walk, that person will start decreasing time spent on activities they enjoy. If the initial problem is not treated, it may lead to further issues such as skin infections, deformities, and muscular problems."

Lesser toes are important in walking, especially when pushing off with the foot towards the next step, bearing the majority of the weighted pressure in support of the big toe and the ball of the foot. A variety of causes can lead to lesser toe deformities, such as:

• Improper footwear, such as shoes with pointed toes or tight toe-boxes;
• Injury;
• Inflammatory arthritis;
• Neuromuscular and metabolic diseases, such as cerebral palsy, multiple sclerosis, or rheumatoid arthritis; or
• Genetics.

The most common lesser toe deformities include: hammer toes, claw toes, mallet toes, curly toes, crossover toes, and bunions. In all of these conditions, the toe is bent, curled, or misaligned in a way that makes normal walking painful. Symptoms, in addition to pain, also include redness, swelling, and sores or calluses where the bent toe rubs against the inside of a shoe.

Dr. Shirzad also notes that while diabetes isn't a direct cause of lesser toe deformities, diabetic patients with neuropathy may not notice when a toe has become painful. They, and others with reduced sensation in their extremities, should be especially aware of any injury or changes in their toes.

Lesser toe deformities can often be treated nonsurgically, but if the patient doesn't respond well to those treatments, surgery is also an effective option. Nonsurgical treatments can include pads or gel sleeves to reduce pressure on the toe joint; or wraps, tape, or shoe inserts designed to guide the toes into a proper alignment. Surgery may involve reconstruction of the soft tissues, bones, or a combination of both.

While some causes of lesser toe deformities are not preventable, one of the most common causes is footwear. Shoes that don't fit well are responsible for many toe deformities as well as other foot problems.

"The most important thing the public should take from this is to be conscious of your footwear," Dr. Shirzad says. "Well-fitted shoes that do not pinch the foot or constrict the toes can prevent many toe deformities."