In medicine, toes 2 to 5 are referred to as small toes. The most common types of deformities in this area are hammer toes, claw toes and claw toes and, much less frequently, bunions.
Hammer toes are primarily characterised by either a flexible (i.e. correctable by external pressure) or a contracted (i.e. fixed) flexed position in the metatarsophalangeal joint. This may also be accompanied by an extensor position of the metatarsophalangeal joint, whereby the end tuber usually does not lose contact with the ground. If the flexion contracture is only present in the end joint, it can also be referred to as an end-joint hammer toe or a “mallet toe”.
Claw toes show the exact opposite of an extensor position of the metatarsophalangeal joint and a flexor position of the distal joint. The extended position of the metatarsophalangeal joint prevents the distal phalanx from touching the ground. The term “claw toe” is sometimes used for a very pronounced claw toe position.
In the case of a tailor’s bunion or bunionette deformity, a congenital increase in the distance between metatarsal heads 4 and 5 leads to a malalignment in the metatarsophalangeal joint of the 5th small toe. It can be recognised by the painful callus that is usually present on the side of the little toe.
Other small toe deformities with flexion or rotational deformities such as the “curly toe” are relatively rare in relation to those mentioned above.
Numerous theories on the development of small toe deformities have been published, whereby ultimately, as is known for most foot deformities, a variety of causes (multifactorial genesis) must be assumed. It is known that an imbalance of the muscles and tendon insertions involved in the development of small toe deformities causes the deformity. Genetic factors (e.g. tailor’s bunion) or acquired deformities in the context of underlying diseases (e.g. rheumatism) also play a role.
Small toe deformities can usually be easily diagnosed by a doctor during a clinical examination. However, this alone is often not enough to determine the treatment. Important anamnestic key data such as usual footwear, professional activity and previous illnesses should be enquired about during the initial consultation. It is also important to consider hindfoot misalignments and shortened calf muscles. In the area of the small toes, it is also important to differentiate between flexible and contracted deformities, which can be done by clinical examination. Furthermore, attention must also be paid to plantar calluses, which can be an indication of incorrect loading.
As a rule, a weight-bearing X-ray of the foot is taken in 2 planes. The bony misalignments are analysed and therapeutic considerations for correction are made. In some cases, special images may be necessary.
Although small toe deformities cannot usually be permanently corrected by plasters or customised insoles, it is often possible to improve symptoms. If such conservative therapies are no longer sufficient, the toe can be corrected well and usually permanently through surgical measures.
Thanks to advances in minimally invasive foot surgery, flexible deformities in particular can now be corrected very well and with few complications using this technique. Conventional techniques can be used for very contracted and pronounced deformities. In this case, the deformities are effectively eliminated by a combination of tendon interventions and bone cutting or stiffening. A wire is often inserted into the toe for stabilisation after the operation, which is removed after 6 weeks.
With minimally invasive toe correction, it is crucial to fix the corrected toe in the desired position with a tape bandage for 6 weeks. A 2-weekly change of tape bandage is desirable. Otherwise, full weight-bearing in a prefabricated orthopaedic partial foot relief shoe is permitted for all small toe procedures. This should be worn for 6 weeks. After 6 weeks, a medical check-up is carried out and it is then possible to wear the prefabricated shoe again. If wires are inserted in the area of the little toes, these are also removed after 6 weeks in the consultation. No local anaesthetic is required. Driving is usually permitted after 6 to 8 weeks.
Following an individual risk assessment, if the ankle joint is not immobilised and the leg is fully weight-bearing, thrombosis prophylaxis with medication can be dispensed with.
Specialist in orthopaedics and trauma surgery, specialised orthopaedic surgery
“Numerous deformities and wear and tear disorders of the foot and ankle can also be treated excellently using minimally invasive techniques.”
Do you have questions about treatment and therapy for hammer/claw toes? Our podiatrists will be happy to provide you with detailed information and advice in a personal consultation. Simply make an appointment. We look forward to seeing you.
Sehr geehrte Besucher,
Sie verlassen nun den Internetauftritt der ECOM® – Praxis für Orthopädie, Sportmedizin und Unfallchirurgie Dr. Erich Rembeck, Dr. Alexander Rauch, Prof. Dr. Hans Gollwitzer, Prof. Dr. Patrick Weber – Ärztepartnerschaft aus München.
Sie werden weitergeleitet auf den Internetauftritt von ECOM – Zentrum für Regenerative Medizin und Stammzelltherapie Dr. Erich Rembeck, Dr. Alexander Rauch, Prof. Dr. Hans Gollwitzer, Prof. Dr. Patrick Weber in Thiersee, Österreich.
Die im folgenden beschriebenen Therapien finden ausschließlich in Österreich statt und sind von der Ärztekammer Tirol, sowie der Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES) genehmigt.
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