JBJS | Lesser-Toe Abnormalities

The Journal of Bone & Joint Surgery, Volume 84, Issue 8

Instructional Course Lecture | August 01, 2002

Lesser-Toe Abnormalities

Michael J. Coughlin, MD

The Journal of Bone & Joint Surgery. 2002; 84:1446-1469

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Although the lesser toes appear to be inconsequential because of their size, pain and deformity of the lesser toes may be a disabling condition. The underlying causes are frequently attributed to high-fashion footwear because of the high incidence of these problems in women ¹ . Thompson and I ² observed an increased incidence of hammer toes and neuromas in the female population with advancing age and a relatively low incidence of similar problems in men. While ill-fitting shoe wear may be the most common cause, other factors associated with lesser-toe deformities include inflammatory arthritis, trauma, congenital abnormalities, and neuromuscular disorders. The basic anatomic shape of the toes and metatarsals may play a role in later development of lesser-toe deformities. Inflammatory arthropathies including gout, rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and nonspecific synovial inflammatory disorders may be a precursor to metatarsophalangeal and lesser-toe disorders ^3-5 . Isolated or repetitive injury to the interphalangeal or metatarsophalangeal joints may lead to the development of a mallet toe ⁶ , a hammer toe ⁷ , or a Freiberg infraction ⁸ . Congenital deformities associated with the forefoot include a crossover fifth toe, contracted lesser toes, and malalignment of the metatarsophalangeal joint. Neuromuscular diseases including muscular dystrophies, Charcot-Marie-Tooth disease, poliomyelitis, and even lumbar disc disease may lead to a contracture deformity of the metatarsophalangeal and interphalangeal joints of the lesser toes ⁵ .

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Topics

toes ; hammer toe ; metatarsophalangeal joint ; corn of toe ; conservative therapy

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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