Toe deformities

Toe deformities are pathological deviations of one or several toes from the anatomical norm. The most common deformity is hallux valgus, a lateral deviation of the large toe at the metatarsophalangeal joint. The etiology of hallux valgus is multifactorial and includes biomechanical instability, poorly fitting shoe wear, neuromuscular diseases, and connective tissue disorders. It presents with pain and inflammation of the metatarsophalangeal joint. Treatment options include special footwear and inlays, pain management and corrective surgery. This article also discusses hallux varus, hammer toe, and claw toe.

• Conventional x-ray of the foot
  • The lateral and medial sesamoid bones function as a divider of muscle tendons.
  • Both sesamoid bones form part of normal human anatomy and are radiologically detectable.

Do not confuse the protruding lateral and medial sesamoid bones with pathological structures!

• Definition: A lateral deviation of the large toe at the metatarsophalangeal joint, often with concurrent rotation of the large toe. A prominent first metatarsal head, potentially with soft-tissue swelling, is also present.
• Epidemiology
  • Most common forefoot deformity
  • ♀ > ♂
• Etiology: multifactorial
  • Biomechanical instability
  • Poorly fitting shoe wear
  • Arthropathies (e.g., rheumatoid arthritis)
  • Connective tissue disorders (e.g., Ehlers-Danlos syndrome)
  • Neuromuscular diseases (e.g., multiple sclerosis)
• Clinical features
  • Pain and inflammation
  • Secondary osteoarthritis in the first metatarsophalangeal joint
  • Can lead to deviation of the remaining digits resulting in hammer and claw toes
• Diagnostics
  • Inspection
  • X-ray of the feet
• Treatment
  • Conservative therapy
    • Special shoes and inlays
    • Orthoses
    • Pain management with NSAIDs and corticosteroid injections
  • Corrective surgery is indicated if conservative therapy fails to relieve symptoms.

See also “Diabetic foot deformities.”

• Hallux varus
  • Definition: medial deviation of the big toe at the metatarsophalangeal joint
  • Etiology
    • Most common: consequence of corrective surgery for hallux valgus (e.g., osteotomy)
    • Rarely: congenital , traumatic, idiopathic
• Hammer toe
  • Definition: a deformity of the lesser toes characterized by PIP flexion, DIP extension, and neutral MTP
  • Epidemiology: most common deformity of the lesser toes
  • Etiology
    • Poorly fitting shoe wear
    • Polyneuropathy (e.g., diabetes mellitus, alcoholism)
    • Friedrich ataxia
    • Rheumatoid arthritis
    • Trauma
    • Charcot-Marie-Tooth disease
• Claw toe
  • Definition: a deformity of the lesser toes characterized by MTP hyperextension with PIP and DIP flexion
  • Etiology
    • Poorly fitting shoe wear
    • Polyneuropathy (e.g., diabetes mellitus, alcoholism)