Small Toe Deformities: Treatment Options

Small Toe Deformities: Treatment Options

This video will review the general treatment options of lesser, or small, toe deformities. Discussion will be focused on the most common deformities of the small toes, including hammertoe, mallet toe, claw toe, and crossover deformities.

Small toe deformities are generally the result of an imbalance in ligaments, tendons, and muscles that surround the toe. When this occurs, a patient may report pain in the affected toes and seek treatment.

Nonoperative treatments for toe deformities are generally trialed first prior to considering surgical intervention. Given poorly fitting shoes contribute to this problem, the first treatment recommendation is to modify existing shoe wear. Use of shoes with a wider toe box can relieve symptoms and assist in preventing progression of the deformity.

Pressure relief may be provided by toe sleeves and padding over the painful joints. A health care provider may recommend exercises to help strengthen the small muscles in your foot.

When nonoperative treatments fail to provide relief in pain or a patient is having wounds due to the deformity, surgery may be considered to restore alignment of the joints. Discussion will begin with the surgical treatment of hammertoe, given its commonality with mallet and claw toe deformities.

Before a surgical path is chosen, the surgeon will examine the toe to assess the amount of movement that is present. It is important to know if the deformity is fixed or flexible before an option is chosen. Mild, flexible deformities may be treated with a tendon procedure called a tenotomy. Here, the affected tendons will be cut to relax the position of the toe. Often, this minor procedure can be done in the office.

If this is not sufficient, a tendon transfer will be considered. Here, the surgeon will cut the tendon on the bottom of the toe, then divide a portion of the cut tendon, and finally transfer the 2 portions to the top of the toe where it is secured. This helps provide additional flexion support to the toe. There are other versions of this procedure in which the tendon is passed through the bone and secured with a screw.

If a toe deformity is fixed, consideration will be made to fuse the affected joint into the proper alignment. This is called an arthrodesis. A fusion may be done in conjunction with a tendon lengthening and/or a repair of the planter plate, the thick ligament at the base of the toe. There are many surgical implant options to help hold the joint in position while it fuses. These options may include external temporary wires or internal permanent screws that provide compression of the joint.

Surgery for crossover toe deformities differs. In these deformities, a horizontal shift in the toe occurs. This deformity is characterized by a failure of the ligaments that surround the toe. There is both a tear in the planter plate and failure in the collateral ligaments on the side of the toe. These deformities can be more challenging to repair. Surgical treatment focuses on repair of the plantar plate tear and tendon transfer procedures. Most commonly, a small incision will be made on the top of the foot near the affected toe.

Following any surgical procedure, a surgical dressing and postoperative shoe will be advised along with restricted weight-bearing. A surgeon may also advise taping or a splint temporarily to maintain the new position.