Lesser Toes

Problems with the small toes
 
Some questions answered


What are the small toes for?

The small toes are important in walking, especially when pushing off with the foot towards the next step. They share the pressure with the big toe and the ball of the foot.
 
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Why do they become deformed?

Toes become deformed when the pressures on the toe are stronger than their joints can resist. This may because the joints are weak or the pressures strong, or both.
 
The joints may be weak because they have been damaged by injury or arthritis. The muscles that control them may become unbalanced, so that one set pulls harder than others and causes the toe to bend. In some people the tissues in the lower part of the joint at the base of the toe (metatarso-phalangeal joint or MTPJ) become weak, allowing the base of the toe to drift upwards and unbalancing it.
The main pressures which cause toes to become deformed come from shoes which press on the tip of the toe, either because the shoe is tight or because it has a high heel, which tends to force the toes into the tip of the shoe. 
 
Pressure on the toe may be because the toe (usually the 2nd toe) is naturally longer than the others, or because the big toe has been shortened by surgery or injury. The pressure from the shoe gradually causes the toe to buckle and this weakens the tissues in the metatarso-phalangeal joint further. The metatarso-phalangeal joint bends up and the next joint to it (proximal inter-phalangeal joint or PIPJ) bends down. The end joint of the toe (distal inter-phalangeal joint or DIPJ) may bend down (usually called a claw toe), stay straight or bend up (usually called a hammer toe).
 
As the MTPJ bends up, the toe may curve over the next toe and rub on it. This is especially common in the 2nd toe, particularly if the big toe bends towards the second toe (hallux valgus, or bunion).
 
Sometimes the whole toe does not bend. The DIPJ may just bend downwards itself while the rest of the toe remains straight (usually called a mallet toe).
 
Other toe deformities mainly occur in children and are due to abnormalities in the growth of the toes.
 
  • the 5th toe may curve over the other toes
  • the 2nd, 3rd or 4th toes may curl and curve under neighbouring toes - this is because one of the tendons is "too short" for the toe
  • various other toe deformities may occur in children, sometimes together with other foot or leg abnormalities, often on their own.
 
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What problems do deformed toes cause?

The main problem with deformed toes is that they tend to rub on shoes, either on top of the PIPJ or at the tip, or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw.
 
If the MTP joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot ("metatarsalgia").
 
Bent toes may rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).
 
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My toes are curled and rub on my shoe. Is there anything simple I can do?

The most important thing is to buy shoes which have enough room in the toe area for your toes to fit comfortably. Avoid high heels, which tend to force the toes down into the tip of the shoe. Small pads on the top or end of the toe may improve the discomfort. 
 
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I get pain in the ball of my foot. Is this caused by my deformed toes?

The toes are probably contributing to the pain at least. There are a lot of causes of pain in the ball of the foot (metatarsalgia). Another page on this site gives more information about metatarsalgia, including advice about self care and when to consult your doctor or chiropodist.
 
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Can chiropody help with deformed toes?

A chiropodist can give advice about shoes and insoles, and can treat the hard or raw skin that develops over some deformed toes. Chiropodists in Britain and most parts of Europe do not operate to straighten toes.
 
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Do I need an operation?

If your toes are interfering with your daily activities and the problem is not helped by the simple measures outlined above, it may be best to have an operation to straighten the toes.
 
Your GP can refer you to an orthopaedic foot and ankle surgeon who will listen to your problems, examine you and advise you on the best method for straightening your toes.
 
There are a number of different operations which can be used, depending on the shape of your toes and how stiff they are:
 
  • the MTP and PIP joints may be freed up to allow them to come straight
  • on of the tendons which curl your toes may be brought up to the top of the toe to help keep it straight
  • a small piece of bone may be removed from the MTP, PIP or DIP joint, or more than one, to allow it to come straight
  • occasionally, the tip of a mallet toe may be removed to shorten the toe and stop it rubbing

Any of these operations may be held stright with a metal pin inserted into the toe, which is later removed.
 
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I've heard the results of toe surgery are terrible. Is this true?

No. Over 90% of toe operations correct the problem for which they were done. A number of problems can occur:
 
  • the deformity can recur
  • the toe may be swollen for several months, or in a few cases permanently
  • stretching of the nerve in the toe can cause tingling, numbness or over-sensitivity in the toe - this usually gets better after a few weeks, but can be permanent.
 
Most people are satisfied with their toe surgery and "terrible" results are rare. Toe surgery is not easy, however, and it is important to have it done by someone with proper training and experience.
 
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