Digital deformities commonly take the form of hammer toes, claw toes, or mallet toes. They are named according to the joints involved. The deformities can be rigid (where they cannot be corrected manually form their deviated position) or reducible (where they can be manually corrected form their deviated position).
The etiology of these deformities is usually an imbalance between the flexor and extensor tendons of the toes. Abnormal foot mechanics (an increase in pronation) can contribute to these tendon imbalances. Because of the deviated toe position, patients may develop painful tylomas (corns) anywhere on the toes as the rub against one another and the toe box of the shoe. Certain foot types, such as an arthritic foot or a high arched foot, can predispose one to digital deformities. Toes can also be partially or completely webbed (syndactyly), large in size (macrodactyly), or extra in number (polydactyly).
Conservative treatment consists of removing painful corns and callused, padding of bony prominences to slow recurrence, selecting shoes with a wide, deep toe box to give the deviated toes extra room, and controlling abnormal foot mechanics (i.e., increased pronation) with orthotics to slow progression of the deformity.
Surgical correction is the definitive treatment. If the deformity is reducible, soft tissue procedures (i.e., tenotomy, tendon lengthening, or tendon transfer) may be all that is necessary. Rigid deformities usually require a combination of soft tissue plus osseous procedures (i.e., joint arthroplasty or arthordesis). Procedures are typically performed on an outpatient basis.
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