Lesser toe deformities

J Am Acad Orthop Surg. 2011 Aug;19(8):505-14. doi: 10.5435/00124635-201108000-00006.


Lesser toe deformities are caused by alterations in normal anatomy that create an imbalance between the intrinsic and extrinsic muscles. Causes include improper shoe wear, trauma, genetics, inflammatory arthritis, and neuromuscular and metabolic diseases. Typical deformities include mallet toe, hammer toe, claw toe, curly toe, and crossover toe. Abnormalities associated with the metatarsophalangeal (MTP) joints include hallux valgus of the first MTP joint and instability of the lesser MTP joints, especially the second toe. Midfoot and hindfoot deformities (eg, cavus foot, varus hindfoot, valgus hindfoot with forefoot pronation) may be present, as well. Nonsurgical management focuses on relieving pressure and correcting deformity with various appliances. Surgical management is reserved for patients who fail nonsurgical treatment. Options include soft-tissue correction (eg, tendon transfer) as well as bony procedures (eg, joint resection, fusion, metatarsal shortening), or a combination of techniques.

Publication types

  • Review

MeSH terms

  • Arthrodesis / methods
  • Arthroplasty / methods
  • Bone Nails
  • Bone Wires
  • Foot Deformities, Acquired / diagnosis*
  • Foot Deformities, Acquired / etiology
  • Foot Deformities, Acquired / physiopathology
  • Foot Deformities, Acquired / surgery
  • Hallux Valgus / etiology
  • Hallux Valgus / physiopathology
  • Hallux Valgus / surgery
  • Hammer Toe Syndrome / diagnosis
  • Hammer Toe Syndrome / etiology
  • Hammer Toe Syndrome / physiopathology
  • Hammer Toe Syndrome / surgery
  • Humans
  • Joint Instability / diagnosis
  • Joint Instability / etiology
  • Joint Instability / physiopathology
  • Joint Instability / surgery
  • Metatarsophalangeal Joint / physiopathology
  • Metatarsophalangeal Joint / surgery
  • Muscle, Skeletal / physiopathology
  • Osteotomy / methods
  • Tendon Transfer / methods
  • Toe Joint / physiopathology
  • Toe Joint / surgery
  • Toes*