Lesser Toe Deformities
Lesser toe deformities are changes in the shape of any of the four smaller toes of your foot. These changes can often cause pain in the toe itself or can be uncomfortable when wearing shoes due to friction and pressure of the toes against the shoe. These changes are commonly seen in the second toe but can affect any of the lesser toes, leading to clawing, curling or overlapping.
Treatment protocols for lesser toe deformities almost always start with basic principles and we would encourage you to consider trying some self-help treatment before making a referral to your local Podiatry department.
What are the lesser toe deformities?
The most common lesser toe deformities are hammer, claw, mallet and overlapping toes. They can occur due to an imbalance between the muscles and tendons within your foot that hold your toes straight. These changes are usually flexible but can become fixed in their new position over time.
A hammer toe is when the proximal interphalangeal joint (shown below) bends down. Due to the change in shape this can result in a corn/ callous developing on the top and/ or tip of your toe. This is most commonly seen in the second toe but can occur in any of the smaller toes. If left untreated can become fixed over a period of time.
A claw toe is when the proximal and distal interphalangeal joints bend down (shown below). Due to this change in shape, you may experience pain and calluses or corns over the top and/ or tip of your toe. If left untreated, the severity of the deformity can increase over time.
A mallet toe is when the distal interphalangeal joint (DIP joint) bends down, as shown below. Due to this change in shape you may experience pain and calluses or corns over the top and/ or tip of your toe. If left untreated it can become fixed over a period of time.
An overlapping toe is often seen alongside a bunion but does not always involve the big toe and is common in the fifth toe as well. This deformity can lead to discomfort and callous buildup over the top of the joints as well as increased pressure between and around the toes.
Classic signs and symptoms of lesser toe deformities:
- Pain and callous and/ or corns over the top of the joints of the toes
- Deformity in the shape of toe
- Shoes becoming uncomfortable over the toes
- Pain and callous underneath the tip of the toe
- Redness and swelling around the joint
- Stiffness in the joints of the toe
- Difficulty walking
What causes the problem?
The change in the shape of your toes occurs as a result of an imbalance between the muscles and tendons which hold your toes straight and those that bend the toes. There can be several reasons for these changes:
- Ill-fitting footwear
- Inflammatory conditions (e.g. rheumatoid arthritis)
- Hallux Valgus
- Neuromuscular conditions (e.g. Charcot-Marie-Tooth disease)
- Peripheral neuropathy leading to a muscle imbalance
What can I do to help?
To improve comfort, you need to relieve the pressure on the toes and there are several ways you can do this yourself.
It is important that you choose footwear that is deep enough to accommodate any hammer toe or clawing deformities. It can also be useful to choose a shoe that has a softer material as the upper. Softer materials can mould around the toes easier than hard patent leathers. If your shoe is not deep enough, it will rub on the prominent joints causing the surrounding skin to become red, swollen and in some cases the skin can blister or become thickened. Sometimes a fluid filled sacs, called a bursa, can develop over the joint. The bursa can also become inflamed and painful.
Toe Pads and sleeves
Over the counter pads and sleeves may help with comfort but ensure you have space in your shoe for these as they may make your shoe feel tighter. These can be used to help with pressure and friction to avoid the toes rubbing or pressing. These devices can be made from various materials and can help to reduce pressure and friction from footwear rubbing. These devices can be bought from your local pharmacy or online.
Pain medication can help reduce your symptoms, allow you to move more comfortably. Your community Pharmacist can provide guidance on specific medication or other methods of pain relief (always read the label and manufacturer’s guidelines).
Strengthening and Stretching Exercises
Strengthening and stretching exercises may help your condition. Your podiatrist will advise you on which exercises are suitable for you.
Strapping and Taping
Strapping/Taping can be used to help support you toe to help guide improved position and stability. This can be a useful short term treatment that can help reduce your symptoms. Your podiatrist will advise you on this.
What else can be done?
If you have followed this advice and your toe pain has not started to improve after a period of three months please refer yourself at your local Health Centre.
Frequently Asked Questions
The information below will answer many of the questions you may have in the early part of your treatment. We aim to ensure your specific needs are considered throughout your treatment. A shared decision making process is used by our teams. This means you will be informed about the treatment options open to you the risks and benefits of each option. You will be supported to make a choice about which treatment best meets your needs.
We hope the following questions that have been developed on the back of MSK focus groups, will provide you with some answers with provide you with key information around your condition.
• What is wrong? Why? What is the cause? Lesser toe deformities are changes in the shape of any of the four smaller toes of your foot. These changes can often cause pain in the toe itself or can be uncomfortable when wearing shoes due to friction and pressure of the toes against the shoe. These changes are commonly seen in the second toe but can affect any of the lesser toes, leading to clawing, curling or overlapping.
• What is the possible impact on my health and function? Many people who have lesser toe deformities do not develop any pain or problems with their feet and require no treatment. However, some people will develop pain and can have difficulty finding comfortable footwear.
Tight fitting shoes can rub on the deformities which can result in your skin becoming red and swollen and in some cases the skin can thicken or blister. Sometimes a fluid filled sac called a bursa can develop over the joints which can become inflamed and painful.
• Will I get better or worse? The good news is that your pain should start to improve by following non-surgical advice that is aimed at easing or removing the pressures caused by the deformities. These measures will not correct or reduce the size or shape of the deformity.
If you have any concerns that you are getting worse or notice any changes in the shape of your foot please contact your local MSK Podiatrist via your local health centre.
• Is it curable? Unfortunately there is no quick or easy fix. Your pain should decrease by following non-surgical advice that is aimed at reducing or removing the pressures that aggravate your symptoms. These conservative measures will not correct or reduce the size or shape of the deformity. It is important to note that if you have any of the contributing factors you will need to consider making the necessary changes to your lifestyle to help aid your recovery.
The one person who can help you get better is you!
• How long will it take to get better? Your symptoms should start to improve within 3 months of following this advice.
• What are you (the health professional) able to do about my problem? By using our self-help tool, we would like to help you to better understand your condition and provide you with the tools which should help support your recovery.
• What is the treatment that is most appropriate for me? Treatment protocols for toe deformities always start with basic principles and we would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department.
• What can I do to help myself to alleviate it? We would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department.
• Why am I not improving? Where have I gone wrong? Am I doing the right things? There could be a number of reasons why your symptoms may not be improving within the three months of following the self-help advice. We would advise you to make contact with one of our MSK Podiatry clinics for further advice/assessment. This can be done by either completing a self-referral form in person at your local Health Centre.
• How can I maintain my function and do the things I want to and need to do? If you are in pain do not try and do all your normal daily activities such as housework, at once. Break the harder jobs down into smaller jobs and do something gentler in between. Extensive walking or standing should be avoided if it aggravates your pain. It is recommended to modify activities rather than to fully stop all forms of movement or exercise. Work out what you can do relatively pain free and use that as a starting point. Then over time build up your activity. Track and write down your progress to keep you motivated.