Lesser Toe Problems
Clawtoe and Hammertoe Deformity
A hammertoe is a term used to describe a crooked, deviated, or contracted toe. Although the condition usually stems from muscle imbalance, it is often aggravated by poor-fitting shoes or socks that cramp the toes. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted, causing an abnormal “v”-shaped bending of the little toes. Patients with this condition often experience pain, swelling, redness and stiffness in the affected toes.
The term hammertoe is almost synonymous with claw toes. The main difference between these two conditions is the position of the MTP joint (in hammertoes this joint is not displaced). However, it is very difficult to clinically differentiate between the two, so they are often used interchangeably.
While most cases of hammertoes are caused by an underying muscle imbalance, it may develop as a result of several different causes, including arthritis, a hereditary condition, an injury, or ill-fitting shoes. In some cases, patients develop hammertoes after wearing shoes or stockings that are too tight for long periods of time. These patients usually develop hammertoes in both feet.
Treatment for hammertoes depends on the severity of the condition, but may home remedies, anti-inflammatory medications, orthotics or surgery for severe cases. Surgery involves removing a small section of bone from the affected joint through a procedure called arthroplasty. Arthrodesis may also be performed to treat hammertoes, which involves fusing together one of the joints in the toe in order to keep it straight. This procedure requires the use of a metal pin to hold the toe in position while it heals.
Patients with metatarsalgia present with pain in their forefoot, usually in the ball of the foot. The pain is often described as aching and it is typically aggravated by standing and walking. In general metatarsalgia is caused by repetitive overloading of the forefoot leading to chronic localized tissue injury. Often the most symptomatic area is at the base of the 2nd or 3rd toe. Factors that may predispose to the development of metatarsalgia include: a bunion deformity, arthritis of the great toe, ligament instability of the midfoot, an excessively tight calf muscle, a congenital foot deformity, and claw toe deformities.
Metatarsophalangeal Joint Synovitis
The metatarsophalangeal joint (MTP) is located in the forefoot where the metatarsal and phalanx bones meet. Synovitis is a swelling of the joint lining. MTP synovitis is a common disorder caused by excessive stress on that joint, usually exacerbated by activity. The ligaments loosen and the joint may develop instability. People with rheumatoid arthritis are at an increased risk of developing MTP synovitis.
MTP synovitis causes pain in the forefoot and sometimes results in an overlapping of the toes. There is often a swelling on the top of the foot near the toes. Patients may experience difficulty walking and wearing shoes as the foot becomes more and more inflamed. The disorder is typically diagnosed through a physical examination and medical history, although at times an X-ray or diagnostic imaging test such as an ultrasound or MRI is necessary.
Treatment of MTP synovitis may vary depending on the severity of the condition, but aims to relieve pain and restore the normal appearance and alignment of the foot. Conservative treatments may include modifying your shoes, wearing orthotics, injections of cortisone or taping the toes in a fixed position. In more severe cases, surgery may be recommended. Surgical options for this condition usually involve an osteotomy or synovectomy.
In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. If the metatarsals move abnormally, they can pinch the nerve between them, which causes inflammation and, eventually, permanent nerve damage. Morton’s neuroma is the most common of this type and affects the nerve between the third and fourth toes.