Lesser Toe Deformities

Mallet Toe Deformity

Mallet Deformity of 3^rd and 4^th Hammer deformity of 2nd

Following flexor tenotomy of distal interphalangeal flexion crease for correction of mallet toe deformity (4^th toe)

Hammer toe of second toe, with adjacent hallux valgus deformity

Definition:

• A flexion deformity of the distal interphalangeal joint
• Either flexible or fixed
• Often the 2^nd digit due to excessive length in comparison to other toes

Symptoms & Signs:

• Pain over dorsal aspect of distal interphalangeal joint (DIP)
• Pain at tip of toe from striking ground
• Callus formation
• Ulceration
• Nail deformity

Physical Exam:

• Standing observation to evaluate severity
• Passive range of motion to determine if fixed or flexible deformity

(If flexible, plantar flexion allows DIP to straighten)

Conservative Treatment:

• Wide toe-box shoes
• Pad tip of toe

Surgical Treatment:

• Flexible deformity - release of flexor digitorum longus tendon
• Fixed deformity – condylectomy, or resection of the distal middle phalanx

Hammer Toe Deformity
Definition:

• Plantar flexion deformity of the proximal interphalangeal joint (PIP)
• Flexible of fixed
• Associated with hyperextension of metatarsophalangeal (MTP) joint
• Typically one or two involved toes

Symptoms & Signs:

• Either fixed or flexible
• Callus formation over PIP extensor surface
• Associated hallux valgus deformity

Treatment:

• Correct shoe wear = wide toe box
• Flexible deformity = Transfer of long flexor tendon to extensor mechanism
• Fixed deformity- Condylectomy of PIP joint - distal head of proximal phalanx
• Both – Correction of Hallux Valgus deformity

Clawtoe Deformity

Definition: Always involves both the MTP and interphalangeal joints. Flexible or Fixed Can be disabling Marked dorsiflexion of MTP joints Forced plantarflexion of the metatarsal heads **Usually involves all of lesser toes, even great toe Etiology: Cavus foot deformity Neuromuscular diseases Cerebral Palsy Charcot-Marie-Tooth Disease Trauma Symptoms & Signs: Pain and chafing over dorsum of PIP and DIP joints Pain beneath metatarsal heads Calluses over PIP joints and under metatarsal heads
	Post-traumatic clawtoe deformity of all digits on right foot

Treatment:

• Extra-depth shoes
• Pad metatarsal heads
• Flexible: Combination of tendon transfers and lengthening
• Fixed: Release of MTP extensor tendons, dorsal capsule, and collateral ligaments +/- PIP condylectomy