Lesser Toes

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Lesser Toes

Problems with the small toes
Some questions answered

What are the small toes for?

The small toes are important in walking, especially when pushing off with the foot towards the next step. They share the pressure with the big toe and the ball of the foot.

Why do they become deformed?

Toes become deformed when the pressures on the toe are stronger than their joints can resist. This may because the joints are weak or the pressures strong, or both.

The joints may be weak because they have been damaged by injury or arthritis. The muscles that control them may become unbalanced, so that one set pulls harder than others and causes the toe to bend. In some people the tissues in the lower part of the joint at the base of the toe (metatarso-phalangeal joint or MTPJ) become weak, allowing the base of the toe to drift upwards and unbalancing it.

The main pressures which cause toes to become deformed come from shoes which press on the tip of the toe, either because the shoe is tight or because it has a high heel, which tends to force the toes into the tip of the shoe.

Pressure on the toe may be because the toe (usually the 2nd toe) is naturally longer than the others, or because the big toe has been shortened by surgery or injury. The pressure from the shoe gradually causes the toe to buckle and this weakens the tissues in the metatarso-phalangeal joint further. The metatarso-phalangeal joint bends up and the next joint to it (proximal inter-phalangeal joint or PIPJ) bends down. The end joint of the toe (distal inter-phalangeal joint or DIPJ) may bend down (usually called a claw toe), stay straight or bend up (usually called a hammer toe).

As the upper toe bends up, the toe may curve over the next toe and rub on it. This is especially common in the 2nd toe, particularly if the big toe bends towards the second toe (hallux valgus, or bunion).

Sometimes the whole toe does not bend. The distal part of the toe may just bend downwards itself while the rest of the toe remains straight (usually called a mallet toe).

Other toe deformities mainly occur in children and are due to abnormalities in the growth of the toes.

  • 5th toe may curve over the other toes
  • 2nd, 3rd or 4th toes may curl and curve under neighbouring toes – this is because one of the tendons is “too short” for the toe
  • Various other toe deformities may occur in children, sometimes together with other foot or leg abnormalities, often on their own.

What problems do deformed toes cause?

The main problem with deformed toes is that they tend to rub on shoes, either on top of the proximal part of the toe or at the tip, or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw.

If the MTP joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot (“metatarsalgia”).

Bent toes may rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).

My toes are curled and rub on my shoe. Is there anything simple I can do?

The most important thing is to buy shoes which have enough room in the toe area for your toes to fit comfortably. Avoid high heels, which tend to force the toes down into the tip of the shoe. Small pads on the top or end of the toe may improve the discomfort.

I get pain in the ball of my foot. Is this caused by my deformed toes?

The toes are probably contributing to the pain at least. There are a lot of causes of pain in the ball of the foot (metatarsalgia). Another page on this site gives more information about metatarsalgia, including advice about self care and when to consult your doctor or chiropodist.

Do I need an operation?

If your toes are interfering with your daily activities and the problem is not helped by the simple measures outlined above, it may be best to have an operation to straighten the toes.

There are a number of different operations which can be used, depending on the shape of your toes and how stiff they are:

  •  MTP and PIP joints may be freed up to allow them to come straight
  • One of the tendons which curl your toes may be brought up to the top of the toe to help keep it straight
  • a small piece of bone may be removed from the MTP, PIP or DIP joint, or more than one, to allow it to come straight
  • occasionally, the tip of a mallet toe may be removed to shorten the toe and stop it rubbing

Any of these operations may be held straight with a metal pin inserted into the toe, which is later removed.

Most people are satisfied with their toe surgery and “terrible” results are rare. Toe surgery is not easy, however, and it is important to have it done by someone with proper training and experience.

 

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