Hammer and Claw Toes

Lesser toe  (ie 2nd to the 5th toe) deformities are also very common.  They can occur in combination with bunions or in isolation.

 

The most common lesser toe deformities are hammer toes (See Fig ). Other common toe deformities are Mallet Toes, Claw Toes, Cross Over Toes, Curly Toes and Bunionettes.

 

A related problem is Metatarsalgia, which is pain at the “ball” of the feet. This often results in painful corn formation, most commonly under the 2nd Metatarsal bone. The underlying cause for this is quite varied, ranging from hammer toes, to abnormally long 2nd Metatarsal bones, to Bunions, Flat Feet, and Tight Calves.

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Hallux Valgus with 2nd and 3rd Hammer toe deformities
The ideal Metatarsal relative lengths are shown below. Deviations from these result in various patterns of metatarsalgia and lesser toe deformities eg the most common pattern is the Morton’s foot or Greek foot in which there is a long 2nd MT. This results in the very common problem of a corn under the ball of the feet at the 2nd toe.. It can also give rise to Overlapping or crossover toes, hammer toes etc.
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Relative Metatarsal Length – The Ideal
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Corn under 2nd Metatarsal Head because of long 2nd Toe and Hallux Valgus
Pictures courtesy of  LS Barouk, Springer Verlag

 

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Patient with a painful corn at the long 2nd metatarsal (Morton’s Foot), and Hallux Valgus
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Same patient. Correction of Hallux Valgus with Scarf Osteotomy and shortening of the 2nd Metatarsal with a Weil osteotomy
Corrections of these variations are quite easily done with a Weil shortening procedure. This is another procedure that allows for quick (4 week) recovery with minimal downtime, and is thus a very good complementary procedure for the Scarf procedure.

 

Finally, calf tightness has always been recognized to be the main underlying reason for foot Over pronation and Pes Planus. This is commonly associated with Forefoot problems such as Bunion formation and Metatarsalgia. Failure to correct this may result in higher recurrence rates from continued over pronation of the foot. Previously, the traditional procedures to lengthen the Achilles was down at the lower tendon end (requires a cast for 6 weeks) or at the mid calf (no cast but slow recovery). A newer way to lengthen the calf is to do this at the back of the knee. This has a very quick recovery (2 to 4 weeks), cosmetic skin crease incision and best of all does not disrupt the muscle strength of the calf muscle. Thus this procedure can be done in Athletes and Dancers without significant loss of power.

 

Bunionettes are “bunions” of the 5th toe. They are treated in a similar way to Bunions of the big toe.

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Weil Shortening Osteotomy for Metatarsalgia and Hammer Toes

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The bone ends are trimmed and the Weil is held with a tiny threaded pin
Pictures courtesy of  LS Barouk, Springer Verlag