Deformity Of Toes - Cause, Symptoms, Treatment, Exercise

Table of Contents

Description

Toe deformities are frequent problems that happen due to abnormal positioning of the foot bones, insufficient biomechanics, and diseases like arthritis affecting the bones and tissues of the foot.

Toe deformities not only influence the alignment of the bones, joints, and tissues in the foot but can also influence the alignment of the weight-bearing joints like the hips or knees resulting in further problems. The most ordinary toe deformities are hammertoes, claw toes, and mallet toes.

Quick description of foot anatomy

Anatomically the foot is split up into the forefoot, midfoot, and hind foot.
The Forefoot has 4 tiny toes called phalanges and 1 large toe called the hallux or big toe.
Phalanges have three bones and three joints, while the big toe has two bones and two joints.
The midfoot and hind foot have different structures, which are accountable for bearing body weight and performing activities like walking and running.

Causes

Toe deformities can be congenital, present at birth, or may happen later in life from wearing improperly fitted shoes or high-heeled shoes.
Few disease conditions like diabetes, stroke, osteoarthritis, and rheumatoid arthritis influence the functioning of muscles and nerves and may cause tightening of ligaments or tendons resulting in these deformities.
In some other cases, accidents or injuries may result in fractures and lead to toe deformities.
Toes are the digits in the foot and are connected with walking, providing balance, weight-bearing, and other activities.
A variety of toe deformities happen in children’s feet.
They are as follows:
- Hallux Valgus:
- Hammertoe:
- Mallet Toe:
- Claw Toe:
- Curly Toe:
- Polydactyly:
- Syndactyly:
- Bunionette (Tailor Bunion):
- Hallux rigidus

1-Hammer Toe

A hammer toe is the deformity of the second, third or fourth toes.
In this situation, the toe is bent at the middle joint, so that it looks like a hammer.
At first, hammer toes are flexible and may be corrected with simple measures but, if left untreated, they may become fixed and require surgery.

Anatomy

The forefoot is made up of five toes. Each toe has three joints—except for the first (big) toe, which generally has only two joints.
In hammer toe, the injured toe is bent at the middle joint, which is called the proximal interphalangeal (PIP) joint.
PIP joint-This demonstration of hammer toe shows the abnormal bend of the PIP joint.

Cause

Hammer’s toe results from a muscle imbalance that places pressure on the toe tendons and joints.
Muscles work in doubleton to straighten and bend the toes.
If the toe is bent in one position long enough, the muscles and joints tighten and may not stretch out.
Wearing shoes that do not fit accurately is a common cause of this imbalance.
Shoes that are restricted toward the toe push the smaller toes into a flexed (bent) position.
The toes buffing against the shoe, ruling to the formation of corns and calluses, which further exasperate the condition.
Shoes with a higher heel force the foot down and push the toes as opposed to the shoe, increasing the pressure and the bend in the toe.
After some time, the toe muscles may no longer straighten the toe.

Risk factors

Elder individuals are more likely to develop hammer toes. females are at higher risk, because of the construction of women’s shoes.
Injuries to the toes, and being born with a big toe that is short in contrast to the second toe, increase risk.
Arthritis and diabetes can also enhance the risk of foot deformities.

Symptoms

A hammer toe is painful, specifically, when the patient is moving it or wearing shoes.

Other symptoms may include:

Swelling or redness
Not able to straighten the toe
Difficulty walking
A corn or callus on the higher point of the middle joint of the toe or on the tip of the toe.

Doctor Examination

Physical Examination

The doctor will perform a physical examination to identify if the toe joint is flexible or rigid.
These statistics will help him or her committed to the appropriate treatment.

Tests

X-rays-

X-rays give images of dense structures, like bone.
The doctor may order an x-ray of the foot to confirm the diagnosis.

Other tests-

Patients who have diabetes or reduced sensation in their feet can require further testing to identify whether a neurological condition is the cause of the tendon imbalance.

Treatment

Nonsurgical Treatment

In the early stages of hammer toe, when the joint is still flexible, treatment generally consists of simple measures.

Changes in footwear-

The doctor will recommend that patient should avoid wearing tight, narrow, high-heeled shoes.
Shoes should be one-half inch longer than the longest toe, which, for too many people is the second toe, and have a soft, roomy toe box.
The patient may also be able to find out a shoe with a deep toe box that fits in with the hammer toe.
A shoe repair shop can be able to stretch a toe box so that it bulges out around the toe.
Wearing sandals can help, if they do not pinch or rub some other areas of the foot.

Exercises-

Specific exercises may help stretch and strengthen the muscles in the foot.
The patient’s doctor may recommend gently stretching the toes manually or using the toes to pick things up off the floor.

Toe Crunch:

Toe crunch is one of the most important hammer toe exercises.
It includes using the middle joint of the toe to pull the tip of the toe to the base.

How to perform-

Make sure that patient sits in a nice, comfortable chair.
Then put a towel just beneath the upper half of the affected foot.
Keep the heel firmly planted on the ground and use the toes for crunching the towel up.
After the patient has reached the end of the towel, perform the exercise again.
Repeat this exercise about 10-12 times.
If the patient wants to add some resistance, the patient may place an item on the end of the towel.

Manual Hammer Toe Stretching:

How to perform-

The patient can also use a towel to stretch the toes.
Sit on the ground with the legs perfectly outstretched and a towel wrapped adequately around the toes.
Make sure that the patient holds the towel ends with their hands and pulls the toes towards them.
Keep themselves in this position for 20-30 seconds.
The patient may also forgo the towel if they like and try pulling their toes by using their hands.

Toe Taps:

How to perform-

This hammer toe exercise helps to stretch the joint.
As the patient lay down, slowly extend the big toe towards the floor as the patient tries to point the other toes up.
Now hold onto that position for about a second and then tap them gently back down to the floor.
Repeat this exercise about 10-12 times and then reverse this process by slowly pulling the big toe up as the patient keep the other toes on the floor.

Hammer Toe Finger Splint:

The Hammer Toe Finger Splint is also recommended to as a “squeeze” and involves using the fingers for creating little splits between the toes for stretching them.

How to perform-

Sit in a comfortable position and then put one foot up and then place it right on the opposite thigh.
Then slide the fingers slowly in between the toes, slowly pinching the fingers for squeezing the toes together.
Repeat the exercise 12 times. If the person like they can perform each toe simultaneously by putting one finger between them and pinching.

Rolls:

This particular hammer toe exercise includes tapping the toes slowly on the ground from one side to the other.

How to perform-

Start with standing barefoot on some flat surface and try lifting all the toes off the ground, while making sure that the patient keeps the heel planted.
Now bring the toes slowly down on the surface one by one, starting with the small and then ending with the big.
Repeat the exercise 10 times and then move in the opposite direction.
Over-the-counter remedies, using economically available straps, cushions, or nonmedicated corn pads may help reduce the pain.
If the patient has diabetes, poor circulation, or a lack of feeling in the feet, talk to the doctor before attempting self-treatment.

Surgical Treatment

If the toe joint is rigid and no longer mobile, or if nonsurgical treatment does not deteriorate the symptoms, the doctor can recommend surgery.
Surgery is typically done on an outpatient basis using a local anesthetic.
The actual procedure will rely on the type and extent of the deformity.

Tendon lengthening-

For patients with a flexible toe joint, the condition may generally be treated by lengthening the tendons that are causing the joint imbalance.

Tendon transfer-

Some patients with a flexible toe joint can benefit from treatment that involves transferring tendons from the end of the toe to the top of the toe to help pull the joint into a straight position.

Arthrodesis (joint fusion)-

Patients who have a rigid toe joint can undergo tendon lengthening in combination with arthrodesis.
In this surgery, the doctor will remove a small part of a bone in the toe joint to make sure that the toe may extend fully.
He or she will then place an external wire or pin and/or internal plate to hold the bones in place while the bones fuse together.

2-Hallux Valgus

Definition

Hallux valgus is the most general foot deformity. It is a progressive foot deformity in which the first metatarsophalangeal (MTP) joint is affected and is frequently consummate by significant functional disability and foot pain and reduced quality of life. This joint is slowly subluxated (lateral deviation of the MTP joint) resulting in the abduction of the first metatarsal while the phalanges adduct. This frequently leads to the development of soft tissue and bony prominence on the medial side of what is called a bunion (exostosis on the dorsomedial aspect of the first metatarsal head).

Clinically relevant anatomy

The Hallux or first toe is the medio-distal fragment of the foot.
Established by the first metatarsal (effective with two sesamoid bones), the first proximal phalanx, and the first distal phalanx.
Established by three bones instead of four, not like the other toes who have a spare bone called the intermediate phalanx.
The Hallux (first toe) has three synovial joints, which are the following-

Tarsometatarso joint –

Formed between the medial cuneiform bone and the first metatarsal, it does not permit a lot of movement.

Metatarsophalangeal joint –

Joints are the first metatarsal and the first proximal phalanx.
The joint permits the flexion and extension of the first toe and a tiny ab- and adduction towards the center of the second toe. It is also strengthened by ligaments (ligament. metatarsophalangeal collateral and ligament. Metatarso phalanges plantaris).

Interphalangae joint –

Interrelation between the two phalanges of the first toe.
This joint only permits flexion and extension and it is also strengthened by ligaments (ligament Interphalangeal collateralis and ligament Interphalangeal plantaris).

Two sesamoid bones were communicative with the first metatarsal bone.

These sesamoid bones, Preserve the tendons of Flexor Hallucis Brevis FHB (Implant in the tendon of the FHB muscle) Main feature is helping FHB create more force by extending its levers.

Muscles acting on the joint-

Muscle tibialis anterior, Muscle extensor hallucis longus, Muscle peroneus longus, Muscle, flexor hallucis longus, Muscle extensor Hallucis Brevis, Muscle abductor hallucis, Muscle flexor hallucis brevis, Muscle adductor hallucis, Muscle interossei dorsalis I, aponeurosis plantaris.

Causes of Hallux Valgus

Causes is not well established – Few factors have been considered to play a vital role in the development of hallux valgus;
Gender– Ten times more frequent in females.
Footwear (tight pointed shoes)- Wearing tight shoes and/or heeled shoes between 20 and 39 years of age may be an important part of the development of hallux valgus in later years.
Congenital deformity or predisposition
Chronic Achilles tightness
Severe flatfoot
Hypermobility of the first metatarsal cuneiform joint
Systemic disease
Possible that abnormal muscle insertions are partly accountable for hallux valgus
Hallux valgus is also connected with hip and knee OA and is vice-versa connected with a higher BMI.

Symptoms

A distal end of the first metatarsal shifts medially and the proximal phalanx deviates laterally.
First MTP becomes malalignment, leading to a lateral deviation of the hallux and medial displacement of the distal end of the first metatarsal.
Bony expansion of the first metatarsal head.

Mechanism behind this hallux valgus formation-

Begin with the stretching of the abductor hallucis muscle (for example as a result of wearing tight shoes).
The base of the first proximal phalanx (PP) begins to lateralize and abducts.
During walking- The forefoot is turned into pronation, which stretches the medial collateral ligament and the capsular structures of the first MTP joint.
The first MTP joint consists of multiple bones, ligaments, sesamoid bones, and surrounding muscles, all affect other structures as they move or stretch.
one time a threshold degree of valgus of the first PP is reached, the first metatarsal bone starts its way into a varus position.
Hallux is pushed into a valgus position. The capsule becomes weaker and the abductor hallucis tendon turns into a flexor of the hallux.
As the condition advances, multiple muscles tend to worsen the situation as their axis of pull is lateralized.
As a bunion take shape, friction is raised when shoes are worn.
There can be irritation of the MCL ligament of the first MTP joint, which conducts to inflammation and calcification of the joint.
This worsens the pain and bunion size.
In the primary stage, this leads to tenderness of the bunion because of footwear.
The skin around the bunion is hard, warm, and red. after that, the patient may have other complaints due to osteoarthritis.
The bunion keeps operating medially and the pain gets worse.
A general problem in individuals with hallux valgus (pre-operative), is one or more disorders in their gait pattern because of the deformity of the first metatarsophalangeal joint.

Dysfunctions that may be present:

Gait differentiation in the mid-stance (middle stage) and the propulsion phase (late stance).
As the body weight moves ahead on the foot on the ground, the patient will tend to keep his weight on the lateral border of the foot.
This result in a lateral and posterior weight shift
The patient has also a pronation deformity.
The patient is not able to supinate his / her foot and will tend to keep the body weight on the lateral border of the foot which results in a late heel rise.
The period of single-limb support will be over.
When a physical examination is executed, the given indications could be present: Lateral deviation of the MTP joint Swelling of the first MTP joint
Shortening of flexor hallucis brevis muscle.
Tenderness of hallux.
Weakness of hallux abductor muscles.
Pain (primary symptom).

Diagnostic Procedures-

Radiographs –

Using to identify the Hallux Valgus Angle (The angle created between the lines that longitudinally bisect the proximal phalanx and the first metatarsal)

Angle is > than 15°, hallux valgus is diagnosed.
An angle of 45-50° is considered serious.
The degree of deracination of the sesamoids and the level of osteoarthritic change within the first MTP joint should be reviewed as well.
It is not always possible or important to take radiographs to determine the severity of hallux valgus.
Therefore, the Manchester scale was researched.

Treatment-

Non-operative treatment-

Prevention

A hereditary factor or predisposition (for example as a result of a common ligamentous laxity) is not avoidable but other things are.
For example, wearing shoes that fit properly (not too tight) and keeping away the high heels may be important factors in preventing hallux valgus.

Physiotherapy exercise for hallux valgus-

1-Toe points and curls

How to do?

This works on the toe joints by flexing the muscles beneath the feet.
Sit on a comfortable surface with feet about 6 inches away from the floor.
Point and curl the toes gently. perform this exercise for 20 reps for 2 to 3 sets.