Lesser Toes Deformity

What are the small toes for?

The lesser toes are those other than your big toes; they can suffer from a range of deformities which can affect their position and make the toe more likely to be affected by other complications.

The big toe has only one interphalangeal joint, but the lesser toes have two. The most common types of deformities which affect the lesser toes are covered below.

Claw toe. A claw toe is caused by one of the tendons in the foot contracting. The first bone is raised and the second two bones point downwards.

Hammer toe. The three bones in the toe should form a straight line, but with a hammer toe the first bone is slightly raised, the second bone tilts downwards and the bone at the tip is almost flat - this condition is also caused by one of the tendons in the foot contracting.

Mallet toe. Again, this condition is caused by one of the tendons in the foot contracting. The first two bones are straight but slightly raised and the bone at the tip is point downwards.

What problems do deformed toes cause?

Deformed toes tend to rub on shoes, either on top of the bent joints or at the tip, or both. This rubbing may simply be uncomfortable, or the skin can get inflamed.

If the joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot ("metatarsalgia").

Bent toes may rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).

Is there anything simple I can do?

The most important thing is to wear shoes wide enough in the toe area for your toes to fit comfortably. Small pads on the top or end of the toe may improve the discomfort. A chiropodist can give advice about shoes and can treat the hard or raw skin that develops over some deformed toes.

Do I need an operation?

Your consultant will examine your foot using a range of indicators to assess your condition including flexibility, stability and sensation. X-ray will show the surgeon the extent of the deformity.

Most painful lesser toe deformities will require surgery. Claw, mallet and hammer toes can be treated using minor procedures. Surgery can include the release of tight soft tissue and tendon lengthening. However, fusion may be required for more rigid deformities. This will involve the surgeon removing the cartilage from the end of the toe bones in the middle joint. A removable pin is then used to hold the two cut ends together so that the bones can fuse together.

What is the success rate of surgery on the lesser toes?

Over 90% of toe operations correct the problem for which they were done. A number of problems can occur: