The pathology and management of lesser toe deformities

Abstract

Deformities of the lesser toes are common and can be associated with significant morbidity. These deformities are often multiple, and numerous treatment strategies have been described in the literature.The goal of surgical treatment is to improve symptoms by restoring alignment and function, and avoiding recurrence. In order to achieve this, it is essential for the treating surgeon to understand the normal anatomy and pathology of the various deformities.There is a paucity of prospective studies and randomisedcontrolled trials assessing the efficacy of specific interventions.We describe the normal anatomy and biomechanics of the lesser toes, and the pathology of commonly adult deformities. The rationale behind various treatment strategies is discussed and the results of published literature presented. Algorithms for the management of lesser toe deformities based on current literature are proposed.

The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities

“…Based on the latest evidence, several strategies for management of lesser toe deformities suggest different algorithms depending on the type of deformity [4]. These algorithms exclusively contemplate toe shortening procedures such as resection arthroplasty or arthrodesis, but never phalangeal osteotomies.…”

“…The procedures on soft tissues are finally carried out if the deformity requires additional actions in case of residual deformities. Recently, the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) also suggests the addressing of proximal deformities prior to distal deformities [4, 9]. According to our practice, once the IOs are performed, the degree of correction and equilibrium achieved between the intrinsic and extrinsic muscle groups is intra-surgically assessed, then deciding whether or not to perform the flexor and/or extensor tenotomies.…”

“…These deformities occur gradually, often affect multiple toes, and are regularly associated to hallux abductus valgus (HAV) [3]. The progression of the deformity is commonly related to an imbalance between the forces of the extensor and flexor tendons about the proximal or distal interphalangeal joints [4]. Most of the LTD evolve despite podiatric care and lastly require surgical treatment.…”

A Rare Case of Lateral Forefoot Pain: Plantar Adventitious Bursitis

“…The feet transmit the body weight to the ground and maintain the equilibrium of posture during locomotion. During the foot strike, the feet act as a shock absorber and then become the lever for push-off [1]. Since the feet bear the weight of the entire body, the pertinent muscles, tendons, or ligaments are prone to injury.…”

Foot health-related quality of life among elderly with and without lesser toe deformities: a case–control study

“… 12 Third, mallet toe deformity seems to be associated with LTD and inadequate footwear as well as is comprised of distal interphalangeal isolated flexion and hammer toe as a proximal interphalangeal primary flexion deformity, with or without metacarpophalangeal hyperextension, with neutral or hyperextended distal interphalangeal joint. 13 …”