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Lesser toe deformities (claw and hammer toes)

Find out about claw and hammer toes, and how they can be treated

Lesser toe deformities incorporate two main diagnoses. The first is a condition known as claw toes and the second a condition known as hammer toes.

The lesser toe joints have three separate joints. A hammer toe describes the middle joint becoming flexed downwards towards the floor. A claw toe describes the joint nearest the midfoot extending up away from the floor and the middle and furthest joint flexing down towards the floor. Often one condition leads to the other in the affected toes.

These two toe deformities occur once there has become an imbalance needed in the muscles and tendons needed to keep the toes straight versus the muscles and tendons which bend the toe joints. If these imbalances are not addressed over time the joints and tendons will shorten and the deformity will be uncorrectable without surgery. There are many causes as to why this process occurs.

On occasion these conditions may arise due to a recent or earlier trauma to the forefoot which stiffens the toe joints in to a certain position. Neurological conditions may also cause one particular muscle and tendon group to become overactive (spastic muscle tone) and lead to this condition over time.

However, the most common cause of claw and hammer toes is due to the toes being cramped. This can occur due to a condition known as hallux valgus which is often genetic in which the big toe begins to drift inwards at an angle towards the smaller toes. The most common cause for cramping of the toes is due to wearing ill-fitting footwear. Pointed toe footwear and well as flat footwear which is a size or too below that needed are common examples. As a result, claw and hammer toes are common in middle aged females who have historically worn ill-fitting footwear occupationally and socially for many years.

Once these conditions become more established the most obvious symptom will be visible deformity of the affected toes. These conditions may carry no pain or there may be severe discomfort. There is often no relationship between the scale of the deformity and the level of pain an individual experiences as each of us walk with a very different gait pattern.

It is advisable to seek an opinion with an orthopaedic ankle and foot specialist as soon as symptoms become apparent. We are able to offer appointments with experienced clinicians who are able to examine the problematic toes and request specialist x-rays. With a combination of clinical experience, expert physical examination and the results of x-rays our specialists will be able to guide you to the most appropriate management for your individual circumstances.

There is no one best options for these conditions but depending on a variety of factors there may be a better option for each circumstance. If a claw or hammer toe deformity is correctable i.e., flexible then some conservative treatment options may prevent the deformity from worsening. If surgery is considered at this stage it is generally less invasive.

Once these deformities have become fixed i.e., the joints have become rigid in their new position surgery is normally the only option to treat these conditions.

If the cause of an individual’s symptoms are poor footwear sizes and choices then this will need to be addressed as the first line of treatment. In a flexible toe deformity physiotherapy exercises to help strengthen the weak muscles and tendons will be prescribed. Exercises to limit excessive rolling in of the foot (over-pronation) may also be prescribed in some cases.

Almost all cases of claw or hammer toe will be treated with specialist insoles (orthotics) prior to surgery and often post-surgery to prevent a recurrence of symptoms. Our ankle and foot orthopaedic specialists work closely with our in-house orthotist. We have available state of the art technology to analyse each individual's gait pattern for possible contributing causes to claw and hammer toes. Orthotics are lab made and will incorporate specific contours and materials to offload the affected toe joints.

Surgery for claw and hammer toes relies on correcting the underlying muscle and tendon imbalance which is often achieved by tightening an existing tendon across the bent toe joint to straighten it. A second form of surgery for more severe, fixed claw and hammer toes involves cutting ligaments, joint capsules and tendons around the affected toe joints to allow them to straighten.

Your specialist ankle and foot surgeon will discuss the merits of different types of surgery as needed at any follow up appointment. Any questions you have will be answered by our experts.

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