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Lesser Toe Deformities

Claw Toe
 

Definition

Definition
A claw toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Claw toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe. Claw toes are classified into two types based on the mobility of the toe joints, flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually. A rigid claw toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

Cause

The causes of claw toe depend on the presenting type, whether flexible or rigid. A flexible claw toe results from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight resulting in the affected joint curling downwards. On the other hand a rigid claw toe is caused by arthritis within the affected joint. 

Treatment and Prevention

Changing the type of footwear worn is a very important step in the treatment of claw toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the claw toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. 

Other conservative (non-surgical) treatments are more successful when treating flexible claw toe deformities. These include using forefoot products designed to relieve claw toes, such as toe crests and hammer toe splints. These devices will help hold down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication. Different taping techniques can also be recommended by your podiatrists in order to align back to normal a flexible claw toe deformity.  Severe rigid claw toe deformities are generally only corrected through surgery. 

 

Hammer Toes

Definition

A hammer toe is a toe that is contracted at the PIP joint (middle joint in the toe), potentially leading to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Hammer toes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing against the shoe.

Hammer toes are classified based on the mobility of the toe joints. There are two types - flexible and rigid. In a flexible hammer toe, the joint has the ability to move. This type of hammer toe can be straightened manually. A rigid hammer toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses. Follow this link to learn more about hammer toe products.

Cause

Hammer toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joint curling downward. Arthritis can also lead to many different forefoot deformities, including hammer toes.

Treatment and Prevention

Changing the type of footwear worn is a very important step in the treatment of hammer toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the hammer toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes. 

Other conservative (non-surgical) treatments are more successful when treating flexible hammer toe deformities. These include using forefoot products designed to relieve claw toes, such as toe crests and hammer toe splints. These devices will help hold down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication. Different taping techniques can also be recommended by your podiatrists in order to align back to normal a flexible hammer toe deformity.  A severe and rigid hammer toe deformity can only be corrected with surgery

 

Mallet Toes

Definition

A mallet toe is one that is contracted at DIPJ (distal inter-phalangeal joint), the furthest toe joint from the foot. Tightened Ligaments and tendons causes this contracture at the DIPJ, alternatively this can be cause by arthritic changes at the DIPJ. A mallet toe can affect all toes except the big toe. 

Cause

A mallet toe occurs when the joint at the end of the toe cannot straighten. Excessive rubbing of the mallet toe against the top of the shoe can lead to pain and the development of a corn. The tip of the toe is often turned down against the shoe causing pressure and discomfort. Arthritis can also lead to many forefoot deformities including mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Treatment and Prevention

Any forefoot problems that cause pain or discomfort should be given prompt attention. Ignoring the symptoms can aggravate the condition and lead to a breakdown of tissue, or possibly even infection. Conservative treatment of mallet toes begins with accommodating the deformity. The goal is to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a high and broad toe box (toe area) are recommended for people suffering from forefoot deformities such as mallet toes. This prevents further irritation in the toe area from developing. Your podiatrist can recommend other conservative treatments which include forefoot supports such as gel toe caps, gel toe shields, toe crests and insoles/ orthotics.  

 

Overlapping and under lapping toes

Definition

Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. People of all ages can experience forefoot problems. Overlapping toes can occur in any of the toes and can cause extreme irritation if not corrected.

When a patients suffers from an over-lapping or an under-lapping toe (this may be referred to as over- riding or under- riding), the toe affected can either be seen to move under or above an adjacent toe. 

Cause

Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning as it should. People of all ages can experience forefoot problems. Overlapping toes can occur in any of the toes and can cause extreme irritation if not corrected.

Treatment and Prevention

Any problems that cause pain or discomfort in the toes should be given prompt attention. Ignoring the symptoms can aggravate the condition, and lead to callus or corn formation and breakdown of tissue causing ulceration or even infection. 

Conservative treatment (non-surgical treatment) of overlapping toes begins with accommodating the disorder. Shoes with a high, broad toe box (toe area) are recommended for people suffering from overlapping toes. Forefoot supports such as gel toe straighteners, gel toe caps and toe separators are often recommended to keep overlapping toes apart. Custom made silicone toe props can also be designed by your podiatrist to offer long term accommodation for your problem. All of these effective devices are designed to reduce friction to help relieve the discomfort.

Regular reviews with a podiatrist are recommended when patient suffers from severe overlapping toes in order to rule out signs of inflammation and obtain advice on best offloading methods in order to prevent risk of tissue loss/ ulceration, particularly in those patients considered as high risk. 

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