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    Deformities of Greater and Lesser Toes

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    Sylvia Chong
    This document discusses several common deformities of the toes, including hallux valgus (bunions), hallux rigidus, hammer toe, claw toe, and mallet toe. It defines each condition, describes their typical presentation, causes, clinical features, treatments, and differences between some of the conditions. Hallux valgus involves a deviated big toe with bunion formation. Hallux rigidus causes stiffness of the big toe joint. Hammer toe bends one toe joint. Claw toe bends multiple toe joints upwards and downwards. Mallet toe involves an extensor tendon detachment.

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    Deformities of Greater and Lesser Toes

    Uploaded by

    Sylvia Chong
    230 views20 pages
    This document discusses several common deformities of the toes, including hallux valgus (bunions), hallux rigidus, hammer toe, claw toe, and mallet toe. It defines each condition, describes their typical presentation, causes, clinical features, treatments, and differences between some of the conditions. Hallux valgus involves a deviated big toe with bunion formation. Hallux rigidus causes stiffness of the big toe joint. Hammer toe bends one toe joint. Claw toe bends multiple toe joints upwards and downwards. Mallet toe involves an extensor tendon detachment.

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    This document discusses several common deformities of the toes, including hallux valgus (bunions), hallux rigidus, hammer toe, claw toe, and mallet toe. It defines each condition, describes their typical presentation, causes, clinical features, treatments, and differences between some of the conditions. Hallux valgus involves a deviated big toe with bunion formation. Hallux rigidus causes stiffness of the big toe joint. Hammer toe bends one toe joint. Claw toe bends multiple toe joints upwards and downwards. Mallet toe involves an extensor tendon detachment.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    230 views20 pages

    Deformities of Greater and Lesser Toes

    Uploaded by

    Sylvia Chong
    This document discusses several common deformities of the toes, including hallux valgus (bunions), hallux rigidus, hammer toe, claw toe, and mallet toe. It defines each condition, describes their typical presentation, causes, clinical features, treatments, and differences between some of the conditions. Hallux valgus involves a deviated big toe with bunion formation. Hallux rigidus causes stiffness of the big toe joint. Hammer toe bends one toe joint. Claw toe bends multiple toe joints upwards and downwards. Mallet toe involves an extensor tendon detachment.

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    The key takeaways are that hallux valgus, hammer toe, claw toe and mallet toe are common forefoot deformities caused by factors like poorly fitted shoes and underlying medical conditions. The document discusses the clinical features, diagnosis and treatment of these conditions.

    Some common causes of hammer toe include wearing poorly fitted shoes that force the toe into a bent position, such as high-heeled shoes. It can also be caused due to intrinsic muscles shortening over time with the toe bent in one position. Underlying conditions like diabetes, osteoarthritis and rheumatoid arthritis can also contribute to hammer toe.

    Hammer toe typically affects the second or third toe and involves hyperextension of the metatarsophalangeal joint and flexion of the proximal interphalangeal joint. Claw toe affects all toes to varying degrees with hyperextension of the metatarsophalangeal joints and flexion of the interphalangeal joints. Mallet toe involves an avulsion of the extensor tendon insertion at the distal interphalangeal joint.

    Deformities of the Great

    Toes
    Hallux Valgus
    In those who have never worn shoes, big toe is in line with the first
    metatarsus, retaining the slightly fan-shaped appearance of the forefoot
    In those who habitually wear shoes,
    the hallus assumes a valgus
    position & is only referred as
    hallus valgus when the angulation
    if excessive
    Hallux Valgus Angle :
    - Intersection of longitudinal axis of 1st MT
    & proximal phalanx
    - Normal < 15 degree
    Intermetatarsal Angle :
    - Intersection of 1st & 2nd MT
    - Normal < 9 degree
    Hallux Valgus
    Metatarsus primus varus may be :
    congenital
    loss of muscle tone in forefoot in the elderly
    common in rheumatoid arthritis
    Lateral deviation & rotation of hallux, together with hypertrophy
    (exostosis) of medial part of metartasal head & overlying bursa which
    together form a prominent bump or (bunion) on the medial side
    Lateral deviation of hallux may lead to overcrowding & sometimes
    overriding of lateral toes
    Hallux Valgus
    Clinical Features:
    Common in women 50-70
    Usually bilateral
    Those with strong family history tendency appears during late adolescence
    Often there is no symptom
    If pain present may be due to :
    shoe pressure on large or an inflamed bunion
    splaying of forefoot & muscle strain (metatarsalgia)
    associated deformities of the lesser toes
    secondary osteoarthritis of first metatarso-phalangeal joint
    Hallux Valgus
    X-ray Findings:
    Standing position to show degree of first metatarsus & hallux
    angulation
    The first metatarsal-phalangeal joint may be subluxated or it may
    look osteoarthritic
    Hallux Valgus
    Treatment:
    In adolescence : conservative due to high recurrence rate (20 to 40%)
    wear shoes with deep toe-boxes, soft upper & lower heels
    if deformity progresses, then corrective osteotomy
    In adults :
    Excision of bunion
    Metatarsal osteotomy & soft tissue rebalancing
    If first metatarso-phalangeal joint is frankly osteoarthritic, arthrodesis
    of joint may be a better option
    Hallux Rigidus
    Arthritis in the foot is at the base of the big toe (metatarsophalangeal
    joint)
    It's important because it has to bend every time you take a step. If the
    joint starts to stiffen, walking can become painful and difficult.
    Ends of the bones are covered by a smooth articular cartilage > wear-and-
    tear or injury damage the articular cartilage, the raw bone ends can rub
    together > bone spur, or overgrowth, may develop on the top of the bone
    > overgrowth can prevent the toe from bending as much as it needs to
    when you walk > hallux rigidus
    Hallux Rigidus
    Symptoms
    Pain in the joint when you are active, especially as you push-off on the toes
    when you walk
    Swelling around the joint
    A bump, like a bunion or callus, that develops on the top of the foot
    Stiffness in the great toe and an inability to bend it up or down

    Investigation
    Physicians examine your foot > look for evidence of bone spurs > move the
    toe around to see how much motion is possible without pain > x-rays will
    show the location and size of any bone spurs, as well as the degree of
    degeneration in the joint space and cartilage
    Hallux Rigidus
    Treatment
    Simple pain killers > stronger pain killers or anti-inflammatory medicines >
    injecting some steroid mixed with local anaesthetic into the joint
    Cheilectomy - removing the bone spurs as well as a portion of the foot bone >
    toe has more room to bend
    Arthrodesis - fusing the bones together (damaged cartilage is removed and
    pins, screws, or a plate are used to fix the joint in a permanent position > the
    bones grow together) - not be able to bend the toe
    Arthroplasty - joint replacement surgery (joint surfaces are removed >
    artificial joint is implanted) - relieve pain and preserve joint motion
    Deformities of the Lesser
    Toes
    Hammer Toe
    Isolated flexion deformity of proximal interphalangeal joint with
    hyperextension of metatarso-phalangeal joint of second or third toe
    Distal interphalangeal joint is straight or pulled into hyperextension
    May produce a painful corn on dorsally
    projecting proximal interphalangeal joint when
    wearing covered shoes
    Hammer Toe
    Causes:
    Wearing poorly-fit shoes that can force the toe into a bent position as
    in high-heeled shoes
    Toes bent for long time cause intrinsic muscles to shorten
    Can also be seen in diabetes mellitus,
    osteoarthritis, rheumatoid arthritis,
    stroke, Charcot-Marie-Tooth disease
    Hammer Toe
    Treatment:
    Operative correction is indicated for pain or for difficulty with
    wearing shoes
    Toe is shortened & straightened by excising the joint then fusing the
    proximal & middle phalanges
    Alternative treatment is to fix toe in straight position with Kirschner
    wire
    Claw Toe
    All toes can be affected to greater or lesser degree
    Metatarso-phalangeal joints are hyperextended & interphalangeal
    joints are flexed
    If all toes are involved, maybe associated with pes cavus or some
    other cause of intrinsic muscle insufficiency
    Claw Toe
    Symptoms
    Your toes are bent upward (extension) from the joints at the ball of the foot.
    Your toes are bent downward (flexion) at the middle joints toward the sole of
    your shoe.
    Sometimes your toes also bend downward at the top joints, curling under the
    foot.
    Corns may develop over the top of the toe or under the ball of the foot.
    Claw Toe
    Clinical Features:
    Pain in forefoot & under metatarsal heads
    Bilateral
    Restricted walking
    Initially, the joints are mobile & can be passively corrected; later
    deformities become fixed & metatarso-phalangeal joints subluxed or
    dislocated
    Painful corns & callosities develop
    In very severe cases, skin ulcerates at press sites
    Claw Toe
    Treatment:
    If toe can be passively straightened, may obtain relief by wearing a
    metatarsal support
    If toe cannot be passively straightened, dynamic correction is
    achieved by transferring long toe flexor to extensor
    If fixed deformity, either accepted & accommodated by special
    footwear or treated by interphalangeal joint arthrodesis combined
    with tendon transfer
    Mallet Toe
    Detached or avulsed insertion of extensor tendon to distal
    interphalangeal joint of toe
    Hammer Toe vs Claw Toe

    Hammer Toe
    Second or third toe
    Metatarso-phalangeal joint : hyperextension
    Proximal interphalangeal joint : flexion
    Distal interphalangeal joint : straight/hyperextension

    Claw Toe
    All toes can be affected - greater or lesser degree
    Metatarso-phalangeal joints : hyperextension
    Interphalangeal joints : flexion
    Hammer Toe vs Mallet Toe

    Hammer Toe
    Second or third toe
    Metatarso-phalangeal joint : hyperextension
    Proximal interphalangeal joint : flexion
    Distal interphalangeal joint : straight/hyperextension

    Mallet Toe
    Detached or avulsed insertion of extensor tendon to
    distal interphalangeal joint of toe

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