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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

  1. Neurovascular status
  2. Callosities
  3. Rigidity of the deformity: is it flexible or fixed?
    • a flexible hammer toe should correct when pushing up on the metatarsal head
  4. MTPJ: subluxed, dislocated or congruent?
  5. Drawer test for 2nd MTPJ position - flex MTPJ & perform drawer. 
  6. Tightness of FDL
  7. 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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