What is Toe Deformity Correction?
Toe deformity correction refers to nonsurgical and surgical measures employed in the treatment of toe deformities.
Toe deformity is a condition where there is a misalignment of the toe bones. Common toe deformities include hammertoe, claw toe, and mallet toe. Toe deformities can be present at birth or can occur later in life from wearing improperly fitted shoes or high-heeled shoes. Certain disease conditions such as diabetes, stroke, osteoarthritis, and rheumatoid arthritis affect the functioning of muscles and nerves and can cause tightening of ligaments or tendons, resulting in these deformities. In some cases, accidents or injuries can result in fractures that lead to toe deformities.
Anatomically the foot is divided into the forefoot, midfoot, and hindfoot. The forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Phalanges have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The midfoot and hindfoot have different structures and are responsible for bearing body weight and performing activities such as walking and running.
Characteristics of Common Toe Deformities
In the case of hammertoe, the toe is bent at its middle joint leading to a curling of the toe that resembles a hammer. Hammer toe is commonly seen in the second toe, but can affect other toes as well. Another related condition called a bunion is often seen with hammertoe and involves a bony outgrowth along the side of the foot at the base of the big toe.
Claw toes exhibit an upward bending of the toe joint at the ball of the foot, followed by the toe bending downward in a claw-like fashion at the middle joint and sometimes the end joint. A claw toe can occur in any toe except the big toe.
The mallet toe is similar to the hammer toe except that it involves the upper joint rather than the middle joint, giving the toe a mallet-like appearance at the end of the toe.
Indications for Toe Deformity Correction
Toe deformity correction is indicated when the associated symptoms are affecting your activities of daily living and quality of life. The symptoms of hammertoe, claw toe, and mallet toe is similar, and include feeling pain while wearing shoes and having difficulty finding shoes that fit properly and are comfortable. Poor-fitting footwear can result in hard skin outgrowths from high pressure and friction.
At the onset of the problem, the deformed toe is usually flexible; however, if left untreated it can become rigid and immovable and require surgical treatment. Treatment of toe deformities starts with conservative methods, but if no effective response is seen, surgery is indicated.
Treatments Involved in Toe Deformity Correction
In the early phases of toe deformities, when the joint is still flexible, treatment usually consists of simple measures, such as:
- Changes in Footwear: Your physician will suggest that you refrain from wearing narrow, tight, or high-heeled shoes. Shoes should be half an inch longer than your longest toe, which for many individuals is the second toe, and have a roomy, soft toe box. You may also be able to find a shoe with a deep toe box that houses the deformed toe. A shoe repair shop should be able to stretch a toe box so that it bulges out around the toe. Wearing sandals may be helpful, provided they do not rub or pinch other regions of the foot.
- Exercises: Certain exercises can assist in stretching and strengthening the muscles in your foot. Your physician may advise gentle stretching of your toes manually or utilizing your toes to pick up things from the floor. Your physician may also recommend towel curls to strengthen the toes and restore muscle balance. To do a towel curl, you should put a towel flat under your foot and use your toes to crumple it.
- Over-the-Counter Remedies: Utilising commercially available cushions, straps or nonmedicated corn pads can aid in relieving pain. If you have a lack of feeling in your feet, poor circulation, or diabetes, talk to your physician before trying any self-treatment.
If the toe joint is stiff and no longer mobile or if conservative treatment does not alleviate your symptoms, your doctor may recommend surgical intervention. Surgery is usually performed on an outpatient basis utilizing a general or local anesthetic. The type of procedure may depend on your specific case and the extent of the deformity. Some of the common surgical procedures include:
- Tendon Lengthening: For individuals with a flexible toe joint, the condition can commonly be treated by lengthening the tendons that are causing the joint imbalance.
- Arthrodesis (joint fusion): This is the most common surgical procedure for patients who have a fixed or rigid toe joint and is performed in conjunction with tendon lengthening. In this procedure, your physician removes a small segment of a bone in the toe joint to ensure that the toe can extend completely. Your physician then places an internal plate and/or external wire or pin to hold the bones in position while the bones fuse together.
- Tendon Transfer: This procedure often works well for a flexible toe joint. Tendons attach muscle to bone. The tendon transfer procedure involves transferring tendons from the bottom of the toe to the top of the toe to help pull the joint into a straight position.
After surgery, you may experience some stiffness, swelling, and redness in your toe for 4-6 weeks. Medications will be provided as needed to address these. Even though you will be able to place pressure on your foot immediately after surgery, you should attempt to restrict your activity while the toe is healing. Elevating your foot as much as possible will help expedite the healing process as well as reduce pain. You may need to wear a special shoe or custom insert to help support your toes after surgery.
In addition, you may find walking a little difficult at the beginning of your recovery. Some individuals may use crutches or a cane for a few weeks to help relieve the weight of their foot. After a few weeks, your physician removes any pins or stitches from the treatment site. An exercise program is recommended to help strengthen your toe muscles, prevent the risk of further deformity, and help the toes heal properly.