Dorset Foot & Ankle Clinic

Figure 1 – A Claw Toe. Both joints (the PIP and DIP joints) of the toe are flexed

Figure 2 – A Hammer Toe. The PIP joint is flexed, but the DIP joint is extended

Figure 3 – A Mallet Toe. Only the DIP joint (the end joint) of the toe is flexed

Lesser Toe Problems

The four lesser toes are an important part of the foot. They share the load whilst walking with the big toe and can have a wide normal variation in their general shape and alignment.

The lesser toes can cause problems either in their own right, or can become symptomatic secondary to a significant problem with the big toe, the most common of which is hallux valgus or bunions.

There are a number of conditions that affect the lesser toes and these are detailed below.

Claw and Hammer Toes

A hammer toe occurs most commonly in the 2nd toe, although can occur in any of the lesser toes. The main feature of a hammer toe is a prominence of the first joint of the toe. This causes pressure on shoes and can become painful. The most common cause of hammer toes is a relative imbalance in the muscles of the toe which often arises as a result of overload of the joint at the base of the toe. This usually occurs in patients with bunions, although can occur on its own.

The non surgical treatment of hammer toes involves providing footwear with a high toe box to avoid rubbing as well as strapping and taping for the toe. More severe cases usually require surgery. A number of procedures are available to us and Mr Taylor and Mr Farrar will discuss these with you and decide on the most appropriate surgical procedure to treat you. If the hammer toe is associated with hallux valgus, or bunions, then we will often suggest the bunions are dealt with at the same time to avoid a recurrence of the problem. You may have a wire protruding from the toe for 4 to 6 weeks. This wire is simply removed in the clinic.

Mallet Toes

A mallet toe deformity describes a toe that curls downwards only at it’s tip. This occurs at the distal interphalangeal joint, therefore differentiating it from a hammer toe (see above). In the early stages, the mallet toe may be flexible, in which case it may be possible simply to divide the long tendon on the under surface of the toe. With the ankle and foot pointing downwards (like a ballet dancer) if the distal interphalangeal joint can be brought straight then it may be possible simply to divide the long tendon on the under surface of the toe to bring the tip of the toe to the correct position. If, however, the mallet toe deformity is fixed, you may require a fusion of the joint at the end of the toe. This will be held in place with a small wire, or occasionally a small screw, for 4 to 6 weeks.

Curly Toes

This is a term usually used to describe the shape of toes in children. It is a common condition and occurs as a result of relative over tightness of the flexor tendons, these being the tendon on the under surface of the toe. If they cause problems, a small procedure to divide the tendon is usually sufficient to settle symptoms. Occasionally a more severe deformity can affect the little toe which may also require a larger incision in the skin around the base of the toe to bring the toe into a better position.