Deformities and footwear

This little piggy……

While the first little piggy was at market, the others still had lots to do. This month we are going to look at those smaller toes, which usually get much less attention than the big toe but can get into trouble too.

Digital deformities are an umbrella term for any malalignments in the smaller toes. These can cause other conditions such as corns, onychauxic nails (thickened nails) and joint pain. These digital deformities can either be fixed (no movement in the toe) or flexible (does have movement in the toe). They are commonly caused by ill-fitting footwear, although they may also be inherited.

Types of digital deformities:

Claw toes occur at the middle and end joints of the toe. They usually occur due to weakness of the small muscles inside the foot, causing an overpull of the muscles at the top of the foot. There are many causes from bunions and poorly fitting shoes to underlying medical conditions such as diabetes, neurological conditions eg. Charcot-Marie-Tooth disease or rheumatoid arthritis.

In the early stages, the claw toes are usually flexible and can be treated by wearing shoes with more room in the front of the shoe (toe box) to reduce external pressure pushing the toe down more, or with gentle manipulation of the toe to try stretch the tightened tendons. Foot exercises such as the “Short Foot Exercise” will help to strengthen the small muscles in the foot, which counteracts the overpull of the larger muscles. Your podiatrist can also make of provide you with devices to help splint the toes in an aligned position.

Mallet toes form when the toe bends at the tip of the toe. This deformity can be flexible or rigid depending on the cause, which can be tight footwear or result from trauma to the toe. Quite often with a mallet toe there is a formation of callus on the end of the toe, which can cause some discomfort, and the nail may become damaged. As podiatrists we are able to debride this callus and relieve you of the discomfort as well as make a silicone protective device to reduce the pressure in the area.

Hammer toes have an abnormal bend in the middle joint of the toe. This most commonly occurs in the second toe but can affect the other small toes too. Hammer toes can be caused by injury, arthritis or may form as a result of of a bunion deflecting pressure onto the lesser toes. Corns and calluses may form from the toe rubbing against the shoe. Footwear changes, silicone devices or, in more extreme cases, can be options to help this condition.

Hammertoe, claw toe and mallet toe are very common issues but can be easily avoided.

Hammer toes are usually caused by shoes that are too short, too small, narrow or pointed. Shoes should be accommodating and have enough room for all the toes to sit comfortably and not feel like the toes are rubbing.

How to help your bent toes

Treatment options depend on whether the toes are fixed or can be manually straightened.

If the toes are still flexible, making sure shoes are long enough and deep enough for the toe to straighten will take pressure off the toe. Summer footwear are more forgiving on foot and toe deformities as they are often open toed and not so rigid. It is always a good idea to try footwear on before purchase to make sure they are right for your foot and toe shape.

Toe props are perfect for supporting and protecting hammer, claw or mallet toes. They help to reduce pressure and pain and can be made of leather, gel or silicone. They aim to sit under the toes to straighten them and reduce repetitive and increasing pressure on the toes.

If there is an underlying biomechanical cause, functional orthoses will be needed to address this.

When the toes are fixed, the prime objective is to keep pressure off the joints and reduce the formation of painful corns and calluses. Various silicone and gel protectors are available to protect the joints. In extreme cases, the toes can be surgically straightened.

Lesser toes can feel unimportant and are often ignored until they get painful. As with most foot problems, treating the cause is our prime objective.