LESSER TOES DEFORMITIES
Deformities of the toes
In everyday clinical medical practice meet people with deformities of the toes which except of the aesthetic disadvantage most often generate functional problems of the lower limb afflecting negatively the patients sentiment.
The deformities of the fingers may relate to one or all joints of the toes of the foot.
A variety of the lesser toe (toes with two to five) deformities such as the hammer toe, claw toe, crossover toe and mallet toe may be associated with pain and footwear restriction.
Deformities of the lesser toes may involve the metatarsophalangeal (MTP) or interphalangeal (IP) joint or both and may involve single or multiple digits.
The term CLAW TOES refers to the deformation of all the joints of the finger. The finger takes 'hook' shape and makes difficult for the patient to wear shoes of his choice.
Claw toe deformity. The metatarsophalangeal joint in extension and proximal and distal interphalangeal joint are in flexion
HAMMER TOE deformity characterized by flexion of the proximal interphalangeal joint. With weight bearing the metatarsophalangeal joint appera dorsiflexed however, this should correct with elevation of the foot off the ground.
A MALLET TOE consist of an isolated flexion deformity at the distal interphalangeal joint.
Hammer toe deformity
Painfull press point on the 2nd toe
- They occur throughout life, although are most often seen in the seventh and eighth decades.
- Women are affected four to five times more often than men.
CAUSE
The deformities of the toes may be due to several factors.
- In pes cavus (high arch than normal)
- Genetic factors
- Poorly fitted shoes - usually the result of wearing shoes that are too short. (Many people have second toes that are longer than their big toes. If they wear shoes sized to fit the big toe, the second toe has to bend to fit into the shoe - causing mallet toe. High-heeled shoes with pointed toes are also a major cause of claw toes.)
- The rheumatoid or psoriatic arthritis sometimes creates serious deformation of the fingers.
- Neurological diseases - Charcot-Marie- Tooth syndrome, cerebral palsy which create imbalance of the forces exerted by the tendons in the fingers.
- Trauma of the foot.
SYMPTOMS
Pain of the toes due to inflammation of the joints (rhematoid arthritis), or the callus formation and nail dystrophy.
The person finds it difficult to wear the shoes, and thus starts to restrict the mobility. This results in the patient becoming overweight thereby exacerbating this problem
This set of things creates psychological problems in the patient leading him to further reduce physical activity.
CLINICALL EXAMINATION
The specialist in surgery of the foot and ankle Orthopaedic surgeon will evaluate clinically the feet, identifying thus the reason for the existence of claw toe, hammertoes, the stiffness of the deformation, the chronicity of this and the coexistence of other problems in the foot (bunions, hallux valgus, pes cavus)
They should also assess the general health of the person that is the investigation of diseases which may be the cause of the occurrence of deformities (psoriasis and psoriatic arthritis, neurological problems, etc).
The evaluation of the patient's gait problems in the fingers is necessary as well as the clinical monitoring of other joints can be affected by the condition of the legs (knees).
X-RAYS AND LAB TEST
- The radiological examination -X-ray- of the feet is the basic examination.
The blood tests for the investigation of autoimmune diseases (rheumatoid arthritis), and the control of blood glucose for diabetes is necessary.
The evaluation of vascular condition -triplex-, of the lower limb, will help to Orthopaedic surgeon about the skin's ability to heal after the operation.
