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Anatomically, the foot is divided into three parts: the forefoot, the midfoot and the hindfoot.
The forefoot has 4 small toes divided into 3 phalanges and a large one called the bunion divided into 2 phalanges. The midfoot and hindfoot have different structures, which have to support the weight of the body and perform activities such as walking and running.
Toe deformities are common problems that occur due to abnormal positioning of the foot bones, inadequate biomechanics or diseases such as arthritis that affect the bones and tissues of the foot. The deformity not only affects the alignment of the bones, joints and tissues of the foot, but can also affect the alignment of weight-bearing joints such as the hips, knees or ankles, leading to other problems. The most common deviations are hammer toe, claw toe and mallet toe.
Bunion is a bit of a departure from the various toe deformities. In fact, in the case of a bunion, the deformity is located upstream of the toe, at the joint between the metatarsal and the first phalanx.
Claw, hammer and mallet deformities differ mainly in the specific joints affected.
Indeed, the hammer toe is deformed at the proximal inter phalangeal joint, i.e. between the 1st and 2nd phalanges. The mallet toe, on the other hand, is deformed at the distal inter phalangeal joint, that is, between the 2ᵉ and 3ᵉ phalanx. As for the claw toe, it cumulates these two deformities, and it is the proximal and distal inter phalangeal joints that are affected.
Differences between hammer toe, claw toe and mallet toe
There is also a difference in the toes most likely to be affected and their most likely causes. Hammer toe deformity is relatively more likely to affect only the second toe and to be caused by tight shoes, whereas claw toes more commonly affect all four small toes at the same time and can be attributed to an underlying condition such as nerve damage or poor circulation. It may be associated with bunion. However, there are many exceptions to these general observations.
Claw is the most common deviation.
It can also be noted that wearing a shoe that is too short and too narrow can cause these types of deviations, which may be compounded by overlapping of the affected toes.
Toe deformities can be congenital, present at birth, or can occur later in life due to wearing ill-fitting shoes or high-heeled shoes. Certain diseases such as diabetes, stroke, osteoarthritis and rheumatoid arthritis affect the functioning of muscles and nerves and can cause ligaments or tendons to retract, resulting in a deformity.
In some cases, accidents or injuries can lead to fractures and deformity of the toes. The underlying condition must of course be treated at the same time as the symptoms to avoid recurrence.
The symptoms associated with all deviations are similar and include pain when wearing shoes and difficulty in finding well-fitting, comfortable shoes. Poorly fitting shoes can lead to hard skin growths (corns or calluses) due to high pressure and friction.
Pain from deviating toes can make walking impossible, often due to the toes rubbing against the shoe upper.
At the beginning of the process, the deformed toe is usually flexible, but if left untreated, it can become rigid and unmovable, requiring surgical treatment. It is therefore recommended consulting your doctor for early treatment measures.
Deformities are simply diagnosed by a physical examination of your feet and no diagnostic tests are usually necessary. However, in cases where the doctor suspects nerve damage, special tests may be ordered.
In the first instance, deformities are treated with conservative measures to restore or maintain walking ability, to relieve pain, and also to delay the progression of the deformity.
As with bunion, the right treatment for your feet will be discussed with you by your doctor or a qualified healthcare professional.
Conservative treatment includes specially designed footwear with a wider than normal forefoot width to avoid excessive tightness. You will be asked to avoid wearing tight, narrow or high-heeled shoes. Toe separators can be custom-made by a podiatrist to reposition the toes and regular stretching exercises are also recommended.
Stretch fronts often reduce the amount of pressure between the foot and the shoe upper and thus reduce the risk of corns and calluses.
Surgery is recommended if conservative treatment fails to relieve the patient's pain, or if the deformed toes become rigid and immobile. The main goal of surgery is to restore the normal alignment of the toes and to return the foot to its normal function without pain.
The surgical procedure is chosen according to the stability of the deformed toe, whether it is flexible or not. There are several surgical techniques that are more or less invasive.
If there is some flexibility in the toe, the surgeon will make an incision in the joint of the deformed toe and realign the tendons and ligaments. Pins may be placed to hold the toe in position during healing. The incision is then closed with sutures and covered with a sterile dressing. This non-invasive technique is done percutaneously and allows for a quick recovery and an easier post-operative course.
In cases where the deformity is rigidly fixed, the surgeon makes an incision in the deformity joint, realigns the tendons and ligaments and also performs an osteotomy, i.e. the removal of pieces of bone. Pins are also inserted to keep the toes aligned during healing. Finally, the incision will be closed with sutures and covered with a sterile dressing.
In addition to the general complications associated with any surgical procedure, other specific complications are insufficient correction of the deformity and stiffness of the toe. Loss of blood supply to the toe and damage to the surrounding nerves are rare but can also occur.
In addition to the general guidelines given by the surgeon after any operation, specific instructions following toe deformity surgery include wearing a special post-operative shoe for at least 2-6 weeks to avoid bending the operated toe. The patient may also be referred to a pedorthist, chiropodist or other qualified health professional for a custom-made foot orthosis to treat static foot disorders.
Author : Philippe Vesin - Pedorthist