Claw, Hammer and Mallet toes

Claw, Hammer and Mallet toes all involve a degree of contracture (stiffness and “deformity”) of the joints of the involved toe. The cause is not in all cases clear. It may result from dysfunction of the small muscles of the foot, an associated deformity of the Great toe (eg crowding with bunion deformity), by forcing the toes into shoes which are too small, trauma or hereditary factors. The joints involved become prominent and rub. In many cases these toes cause no problems at all, however this is not always the case.

Corns are thickened skin caused by friction between bony prominences or bone & the shoe

Most toes with contractures and corns can be managed without surgery. Appearance is not a reason to operate.

Friction between the shoe and a bony prominence causes the skin to thicken and form a corn or a callosity (occasionally even an ulcer) on the dorsum (top) of the toe or at its tip. The corn, not the deformity, is often the most troublesome feature of the problem. Occasionally the affected toe under- or over-lies its partner. An associated contracture of the more proximal metatarso-phalangeal joint will result in prominence of the metatarsal head with callosity forming on the plantar (underneath) surface of the foot which can cause a great deal of trouble. Sometimes the bony prominences or condyles of toes simply become prominent rather the joints being contracted (bent). They may rub on each other or on the shoe. When rubbed by the shoe the callous formed is “hard” but when toes rub together the skin often macerates and causes an extremely painful (and obscure) “soft corn” or ulcer.

 

Most toes with contractures and corns can be managed without surgery. Appearance is not a reason to operate.

Many people suffer only minor complaints, not all need aggressive treatment. Furthermore sometimes a very simple modification of shoes can be of tremendous benefit. Primarily this means ensuring that there is enough room in the toe box of the shoe. Further help may be gained by the use of simple pads (usually silicon sleeves are the best) and the use of simple abrasion of the callosities on a regular basis. These techniques do not always work. Operative intervention may be needed particularly if there is recurrent ulceration or infection.

A combination of procedures is often required. Great toe deformity correction is frequently needed to reduce both crowding & stress

There are a number of surgical options used to correct lesser toe problems. Each addresses a different underlying cause of the toe problem and for this reason they may be used in various combinations. This is simply an overview of a few of the more frequently performed operations. In any case, it is important that if there is a significant deformity of the foot contributing to lesser toe pathology (most frequently hallux valgus – a bunion causing crowding & increased stress), this must be addressed simultaneously. If a significant underlying cause for deformity remains, a recurrence is likely.