The foot is divided into three sections, the hind foot, mid foot and forefoot. The forefoot is comprised of 4 small toes known as phalanges and 1 large toe known as the big toe or hallux. Phalanges are made up of 3 bones and 3 joints while the hallux (big toe) is made up of 2 bones and 2 joints. The hind and mid foot are comprised of different structures and are responsible for bearing the weight of the body and performing tasks such as walking and running.

The tiny bones in the toes can be affected by various disorders resulting in pain and preventing the foot from functioning normally. Toe deformities have been known to affect individuals of all ages from infants who are born with the deformities to older adults who acquire the deformities.

Toe deformities in adults are majorly caused by biochemical imbalances and diseases such as arthritis which cause disruption of the natural function of the foot by a variety of causes leading to the tightening or stretching of tendons to compensate. Thus, individuals who have high arches, flat feet or abnormally long toes are at a greater risk of developing toe deformities.

Toe deformities affect the alignment of the tissues, joints and bones in the foot as well as the alignment of weight-bearing joints such as the knees or hips thus resulting in further conditions.

The most common toe conditions are mallet toes, claw toes and hammer toes.

• Mallet toe: A mallet toe is usually bent at the distal joint area of the toe, with the most common toes being the second or third toes. It can cause persistent corns or a painful nail.
• Claw toes: A claw toe is bent at both the distal and proximal joints of the toe. The deformity is mostly caused by persistent impaction and constriction from ill-fitting footwear.
• Hammertoes: This is a fixed bend at the proximal toe joint. As the toe is deforming, it tends to rub against the shoe and this irritation can lead to painful corns. The corns can also occur between toes due to rotation of the toe which may cause the joints to rub together and create small bone spurs. The skin can also break down and develop infection.

Causes of Toe Deformities

Toe deformities can be present at birth (congenital) or can develop later in life from wearing high heeled shoes or improperly fitting shoes. There are certain diseases such as stroke, diabetes, osteoarthritis and rheumatoid arthritis which can affect the nerves’ and muscles’ functions and cause tightening of the tendons or ligaments thereby resulting in these deformities. Injuries or accidents can cause fractures and also lead to toe deformities.

Symptoms of Toe Deformities

Symptoms of mallet toes, claw toes and hammer toes are similar, and they include feeling pain when wearing shoes and difficulty in finding comfortable and proper fitting footwear. Wearing ill-fitting shoes may cause hard skin outgrowths from friction and high pressure.

As the problem begins, the deformed toe is normally flexible, but if left untreated it can become immovable and rigid requiring surgical treatment.

Diagnosis of Toe Deformities

A physical diagnosis is enough to diagnose a toe deformity. However, if the doctor suspects nerve involvement, then further tests may be ordered.

Treatment of Toe Deformities

Toe deformities are initially treated by conservative treatments to relieve pain, restore and maintain walking abilities and delay the progression of the condition.

These treatments include:

• Wearing custom made shoes with paddings or cushion and an enlarged toe box area so as to prevent the skin from breaking.
• Avoid wearing high heeled, narrow or tight shoes
• Applying tape or splint to reposition the toes
• Toe stretching exercises on a regular basis

Surgical treatment is usually recommended when the conservative treatments fail. The goal of the surgery is to restore normal toe alignment resulting in the normal pain-free function of the foot.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.