Problems with the lesser toes

What use are the toes?

Toes used to be used for gripping like fingers but now their main use is pushing off when walking.  They also distribute the pressure at the front of the foot.

What can go wrong?

The lesser toes can develop a number of abnormal appearances and positions.  ‘Hammer toe’, ‘mallet toe’, ‘claw toe’ and ‘curly toe’ are all terms used to describe toe deformities.

The tendon balance of the toe can become abnormal causing the shape to change and the tissues around the joints in the toes can become torn and unstable.  Alternatively the joints can become arthritic and weak causing the toe to deform.

What problems do they cause?

If the toe takes up an abnormal position this can cause problems with rubbing and the development of callus (hard skin).  Both can cause pain.  This can occur at the tip of the toe where it touches the floor, on top of the toe where it rubs on shoes or inbetween the toes.  The abnormal toe can cause pressure problems under the foot (metatarsalgia).

What can you do about it?

Some toe problems are caused by ill-fitting shoes with not enough room for the toes to sit in their normal position.  It is important to have shoes with a wide, soft toe box.  A chiropodist or podiatrist can remove the hard skin.  You may be able to wear a silicone sleeve over the toe to stop it rubbing or pads under the toe to alleviate the pressure.

Will I need an operation?

If the simple basic measures described above do not help then an operation to straighten the toe may be needed.  A number of operation exist to straighten toes and the operation chosen will depend on the specific shape of your toe.  You will often have a pin down the toe to hold it straight after such an operation, the pin is usually taken out at 4 weeks in the outpatient department.

Are there any risks?

Most operations for the lesser toes are successful but you should be aware of some problems that can occur.  There is a small chance of infection, swelling, recurrence of the deformity and damage to the nerve or artery to the toe.