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Common foot complaints:

Lesser Toe Deformities

Definition
The lesser toes are those other than the big toe. The lesser toes may suffer from a range of deformities. These deformities affect the position of the toe, which then makes the toe more likely to suffer from associated complications related to abnormal position and function.

The lesser toes have two joints within, these joints are called interphalangeal joints. In contrast the big toe only has one interphalangeal joint. The interphalangeal joints of the lesser toes, when weight bearing, should be primarily straight. However their position can vary. There are many theories as to why people develop lesser digital deformities. Though footwear can affect toe position, the inherent structure and function of the foot is likely to be of greatest influence.

The most common types of lesser toe deformities are those of hammer toes and adducto varus deformities. The hammer toe deformity is most commonly associated with the second toe, though all lesser toes can be affected. The toe will be in a flexed position at the first interphalangeal joint, making this joint stand higher than it should, exposing the joint to irritation from footwear. The adducto varus deformity primarily effects the little toe, though it may also effect the forth and third toes, counting from the big toe, this being the first toe. With an adducto varus deformity the toe is usually rotated so that the nail of the toe faces away from the big toe. The toe may be bent towards or under the toe next to it, the fourth toe.

Incidence / Age
Lesser digital deformities are very common. Some lesser digital deformities may cause problems while others may not. They can occur at any age but, as often progressive deformities, symptoms tend to be noted as age increases.

Treatment
Consultation with a State Registered Podiatrist / Chiropodist is always advisable if you think you are developing or have a lesser digital deformity. Conservative treatment centres about the alleviation of pain associated with complications, e.g. corns and calluses. In most instances the only way to correct a lesser digital deformity in adulthood is through surgical intervention. Some of the common treatments used for lesser digital deformities are listed below.

Self treatment
Self treatment for lesser digital deformities can only involve footwear modification or selection. There are no devices available that will correct structural lesser digital deformities once developed.

Shoes: Footwear selection is very important if you suffer from lesser digital deformities. Unfortunately the toe box off a standard shoe is rarely the shape of the forefoot and toes. Choose a shoe that has a wide and high toe box. The shoe must have a restraint such as laces or a strap to prevent the toes being forced forward into the toe box. ‘Flip-Flop’ type footwear should be avoided, as they require the toes to flex to maintain their position on the foot. Shoes with soft leather uppers or training shoes are often found to be comfortable. With more sever lesser digital deformities, special wider fitting shoes are available ready made, or can be made to measure. Such footwear can often ease discomfort. Specially wide or deep fitting footwear is usually described as orthopaedic or bespoke.

Clinical and biomechanical treatments
If you think you have a lesser digital deformity, it is wise to consult a State Registered Podiatrist / Chiropodist. The Podiatrists will carryout a full assessment and advise you upon appropriate treatment lines and referral if necessary. Conservative treatments that are sometimes used in the alleviation of symptoms associated with lesser digital deformities include the following.

The treatment of associated complicating conditions: It is common for lesser digital deformities to be complicated by other conditions, which may cause more problems than the deformity itself. Complicating conditions include calluses, corns and ulceration. The Podiatrist will assess these complications and treat them accordingly.

Biomechanics:
Biomechanical therapies are used by some podiatrists in the maintenance of lesser digital deformities and treatment of associated complications. They are used to influence mechanical abnormalities that are thought to influence progression of the deformity. Biomechanical therapies will not correct existing lesser digital deformities. Some types of lesser digital deformities are temporarily corrected when biomechanical devices are used. Most treatments involve a detailed assessment of gait and the lower limb and the prescription of an insole / orthotic device to be worn in shoe.

Surgical
The only way to correct a lesser digital deformity is surgically. The procedure and complexity of surgery carried out will vary greatly, depending upon the type and severity of the presenting digital deformity. Most digital surgery will be carried out to correct alignment and function at the level of deformity.

Operation options, what will happen during and after the operation, possible complications and the gravity of such complications, will all be discussed with you by the Consultant in charge. For most digital operations a local anaesthetic is all that is required. However other types of anaesthesia commonly used include local anaesthesia with sedation and general anaesthetic. Digital surgery is usually carried out on a day case basis. Post-operative pain is managed by a long acting local anaesthetic injection and analgesic tablets.

Digital surgery is highly effective and recurrence of the deformity following surgery is unlikely.

Outcome / Prognosis
Most digital deformities once established are progressive. Conservative treatments can be used to ease associated symptoms and may slow the development of certain digital deformity. Surgical intervention is available to correct digital deformities.

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