Lesser Toe Deformities
Hammer - flexion of the PIPJ & extended DIPJ
Mallet - flexion at the DIPJ
Claw Toes -
flexion of the IP joints, hyperextension of the MTPJ (intrinsic minus deformity) often associated with a cavus foot and tight TA
Aetiology
- Constrictive footwear, restricts the normal movement of the joints and impedes the intrinsic muscle function
- Neuromuscular diseases - always exclude for all claw toes
- CMT, Freidrich's, cerebral palsy, myelodysplasia
- Other causes
- RA, DM, post compartment syndrome
- Long toe short shoe
The joints are mobile initially but become rigid and the MTPJ joints sublux
Callosities develop under the metatarsal heads or over the inter phalangeal joints
Examination
- Neurovascular status
- Callosities
- Rigidity of the deformity: is it flexible or fixed?
- a flexible hammer toe should correct when pushing up on the metatarsal head
- MTPJ: subluxed, dislocated or congruent?
- Drawer test for 2nd MTPJ position - flex MTPJ & perform drawer.
- Tightness of FDL
- Concomitant hallux valgus
Treatment
Non-operative
In the young patient with a flexible deformity try well fitting shoes with an adequate toe box
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