Lesser Toe Deformities: Hammer, Claw and Mallet Toes

     These types of deformities are most common in the elderly population and most often in women. Claw toe deformity appears as a toe that is bent in the joint closest to the leg. Mallet toe deformity is when a toe is bent in the joint furthest from the leg. Claw toe deformity affects both joints: the closest to the leg (proximal) and furthest from the leg (distal). The cause of these deformities is usually badly fitted shoes or muscle imbalance. The most common cause of hammer toes is the imbalance between intrinsic flexors and extensors of the toes.

    Other causes of these deformities include: diabetes, inflammatory arthritis, peripheral neuropathy, acute injuries, neuromuscular disorders, and congenital malformations. One of the most common issues that cause hammer toes is a bunion. This happens when the big toe pushes on the second toe so that the second toe becomes bent or “hammered”. If the length of the second toe is the longest, shoes that have a small toe box will cause this toe become deformed. Toe box of the shoes that is too narrow can cause deformity in the fifth toe. When wearing narrow short footwear the lesser toes are forced into a flexed position for a long period of time. Then, the muscles adapt and become permanently fixed in this position.

     It is important to determine whether the deformity is flexible or fixed. If the deformity is flexible that means that the toe is bent at the joint but can be manually straightened. The deformity can be passively corrected while avoiding pressure points and fixation in deformed position. A fixed deformity needs to be accommodated for, with orthotics, footwear accommodations, and/or surgery, to decrease high pressure areas and avoid further deformation.

     To lessen discomfort common treatments include: orthotics, footwear modifications, surgery, physiotherapy, and commercial accommodative devices. Orthotic intervention can include a metatarsal bar, toe crest, cushioning, metatarsal pad, and/or a pair of orthotics. Make sure there is a ½ inch is left beyond the longest toe, the toe-box material is soft, and that there is no stitching that can irritate toes and prevent stretching. Footwear can be stretched manually by a pedorthist, chiropodist, or podiatrist to accommodate a deformity. Also, do not to wear shoes with a narrow and shallow toe-box. It will only cause more injury and pain in the problem area.

     The most extreme treatment is surgical intervention. It is done only if the deformity is severe and/or disabling. The type of surgery will only depend on the type of deformity and does not require the client to be non-weight-bearing for too long afterwards. For example, a rigid deformity needs correction and fixation of the bone.

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