Lesser Toe Abnormalities

Definition

Claw Toes

  • Features
    • PIP flexion
    • MTP hyperextension – irreducible
    • ± DIP flexion

Mallet Toe

  • Definition
    • Flexion of the DIPJ

Aetiology

  • Shoe Wear
    • Main cause is ill fitting shoes
  • Anatomic
    • Long second ray with buckling of toe
    • Irregular shaped middle phalanx with deviation of DP
    • Long fourth toe with curling under the third toe
    • Pressure of hallux against second toe
  • Neuromuscular
    • Polio
    • CMT
    • Muscular Dystrophy
  • Connective Tissue Disorders
    • Inflammatory arthritis
  • Trauma
    • Fracture
    • Tendon or Ligament injury
  • Congenital
    • Syndactyly

Epidemiology

  • Claw toes more common in younger population
  • hammer toes more common in older patien

Examination

  • dorsal PIP callus
  • 2nd metatarsalgia
  • coronal plane deformity
  • Dorsum of the PIPJ corn
  • Tip of the toe with end corn
  • Under the MT head with callosity

Treatment

Claw Toes

Non operative

  • Extra shoe depth & metatarsal bar

Operative

  • If cavus deformity of the hind foot or other hindfoot abnormality then correct first
  • Mild: Young patient with no fixed deformity
    • Girdlestone -Taylor flexor to extensor tendon transfer
      • ± extensor tenotomy
      • ± MTPJ capsulotomy
  • ModerateFixed Flexion deformity of the PIPJ
    • 1. Resection PP head & Neck
    • 2. Arthrodesis of the PIPJ
    • ± Extensor capsulotomy or Dorsal MTPJ capsulotomy
  • Severe Subluxation of the MTPJ
    • Needs reduction of the joint through decompression
    • 1. Resection of PP base or MT head
      • particularly in RA
    • 2. MT neck osteotomy (Weil)
      • ± Dorsal capsulotomy or extensor tenotomy