Lesser toe deformities describes a change in the shape of your small toes.
There are different types of lesser toe deformities classified according to the position of the three small bones in each of your small toes. Depending on the change in joint positions, deformity of the lesser toes can be described as:
- mallet toes
- claw toes
- hammer toes
These changes are common in the second toe but can affect any of the small toes.
How common are lesser toe deformities?
Lesser toe deformities can occur in anyone, however they tend to more commonly affect:
- women
- older people
Causes
Risk factors for developing lesser toe deformities include:
- Injury: A traumatic injury such as a fracture or ligament sprain can contribute to a change in the toe joint position.
- Inflammatory Arthritis: The small toe joints can be affected in patients with medical conditions causing inflammatory arthritis, for example rheumatoid arthritis and psoriatic arthritis.
- Altered Foot Function: The presence of existing foot deformities such as hallux valgus (bunions), a long 2nd toe and flat feet can all lead to overloading the small toe joints and changes to the joint position.
- Strength: Poor strength within the core foot muscles and lower limb.
- Age: It is more common in older adults, although it can affect any age.
- Obesity: If you are overweight this can lead to greater stress and load going through your small toe joints as well as the ligaments and tendons that help maintain toe positioning.
- Congenital: You can be born with lesser toe deformities
- Neurological Conditions: Lesser toe deformities can be seen in those with neurological conditions such as stroke, Charcot Marie Tooth disease, cerebral palsy and others.
Symptoms
The main signs and symptoms of lesser toe deformities include:
- Painful callous and corns overlying the joints of the toes and/or pressure points like ball of the foot and tip of toes.
- Feeling of walking on a pebble under the ball of your foot at the associated toe joint affected.
- Deformity of the associated toe with visual changes in the joint structure and toe position.
- Restricted range of movement: limited movement up or down at the associated joint within the small toe.
- Difficulty accommodating toes in footwear.
How long will it take to get better?
Lesser toe deformities, once fixed in position, cannot get better. However, there things that you can do to improve your symptoms if painful. Self-help or self-management is very important to relieve pain and improve function.
What can I do to help my lesser toe deformities?
Treatment is aimed at reducing the stress and load through the affected joint, to allow healing and improving strength around the affected joint.
Changes in lifestyle can also be helpful to aid in your recovery. The one person who can help you manage your symptoms is you.
Footwear
One of the most important changes you can make is to your footwear.
- Avoid high heeled shoes or shoes with a flexible sole as these place increased stress on the joints of the forefoot.
- Avoid slip on shoes as often toes need to grip to keep the shoes on which can contribute to the toe deformity.
- Avoid shoes that have pointed toes or a very shallow toe box.
Look for a shoe that has the following qualities;
- Heels should be broad and no more than 1.5 inches high.
- Soles should be firm and non-pliable.
- Cushioned soles such as running shoes can help with shock absorption
- Deep fitting footwear will provide plenty of room for your toes and accommodate any toe deformity.
- Lacing or Velcro straps to hold the shoe firmly to the foot. E.g. running or walking shoe/boot
- The forefoot of the shoe should have a small rocker to aid with the walking cycle and reduce pain. See our footwear advice video or our footwear advice section for further guidance.
Weight management
If you have a higher than average body mass index (BMI) you are more at risk. Please click here for further support with managing weight.
Activity modification
Avoiding high impact activities and replacing with low impact exercise (for example, replacing running with swimming)
Strengthening and stretching exercises
Targeted strengthening and stretching exercises for the muscles in and around your foot and can help to improve your symptoms. Local NHS Ayrshire & Arran podiatrists have devised exercise videos to help with strengthening the correct muscles.
You can consult our exercises section at the foot of the page for more information.
Toe props
Toe props come in a range of sizes and designs, including:
- a silicon sleeve to cushion the joints of your toes and protect them, helping to prevent corns and callouses
- padding underneath your toes, to help straighten them and prevent build up of corns and calluses on the tips of your toes
Toe props can be purchased from your local pharmacy or online.
Foot orthoses
Foot orthoses may be considered if self-management and exercises have not improved your symptoms. Your local MSK podiatrist may prescribe some foot orthoses to wear in your shoes to try and offload the joint.
Oral pain medication
Non-steroidal anti-inflammatories medication can sometimes be prescribed by your GP.
Investigations and surgery
Do I need a scan?
Lesser toe deformities can be diagnosed via a physical examination and patient history alone. X-rays can confirm changes within the joint and indicate severity. Ultrasound scan can also indicate osteoarthritis as well as confirm active synovitis (inflammation of joint lining).
Will I need surgery?
Surgical management is not usually considered unless you have tried all of the above measures and continue to have difficulty walking.
If the severity of the deformity is significant with minimal scope to improve function then it may be appropriate for a referral to an orthopaedic surgeon to consider a surgical intervention. Surgical options for lesser deformity may include fusion or tendon transfer.
Exercises
The exercises below have been provided to help with your ankle osteoarthritis. If there is any doubt about your fitness to do these exercises then please discuss this with your GP.
You may find that these exercises may slightly increase your symptoms initially. However you should find the exercises themselves will become easier to do and that you begin to move your foot and ankle more easily. The exercises can take up to 12 weeks for you to notice a great improvement.
If these exercises cause a large increase in your pain or after 12 weeks there are no noticeable changes in your day to day symptoms then please contact your GP or NHS inform for more advice.
Pain during exercise
Within the scale, aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by:
- reducing the amount of movement during an exercise
- reducing the number of repetitions
- reducing the weights
- reducing your speed
- increasing rest time between sets
Pain after exercise
Your pain or other symptoms should return to your pre-exercise baseline within 30 minutes of exercising. On the morning after your exercises, you should not feel an increase in pain or stiffness that lasts longer than 60 minutes.
Disclaimer
Please note: These exercises should not be used without prior consultation with a medical professional as the use of the wrong exercise may cause additional health related issues and discomfort. NHS Ayrshire & Arran and MSK NHS Ayrshire & Arran are not liable or responsible for any harm, losses or damages whatsoever resulting from the use or misuse of the information contained in or implied by the provided information in each video. These are provided for information only.
If you have any concerns about your ability to perform exercise then please discuss your concerns with your doctor or healthcare provider prior to participating in any advice that is on the MSK NHS Ayrshire & Arran website.
It is recommended to use your ice pack (cryocuff) or cool pack after your exercises to reduce the pain and discomfort this may cause.
Please choose the most relevant exercise section for you.
1. Seated Toe Grip Strengthening Using a Ball Exercise
This is performed in seated position. Using a small spiky ball. Try to grip the ball with your toes and keep repeating this action. If you get a good grip on the ball try to pick it up.Aim to build to 3 sets of 15 reps daily.
2. Seated Toe Grip Strengthening With Towel Exercise
This is performed in seated position.
Use your toes to begin crunching the towel up with the aim of pulling the towel in towards you, do this in a slow controlled manner whilst maintaining your heel on the ground. When you have pulled the towel in as far as possible straighten it back out again.
Aim to build to 3 sets of 15 reps daily.
3. Resistance Band Strengthening Exercise For Toe Flexor Muscles
This is performed in seated position.
With your leg bent comfortably at 90 degrees with your foot placed flat on a strip of resistance band. Pull the end of the band over your knee towards you which in turn will pull your toes up into a flexed position. Anchor the band on your thigh maintaining a good level of tension on the band throughout the exercise. Hold the band tight and begin to slowly push your toes down towards the ground against the resistance of the band, when your toes reach the ground allow them to slowly raise back up to their starting position.
Aim to build to 3 sets of 15 reps daily.
4. Seated Short Foot Exercises
Start in a seated position with your foot flat on the ground. Straighten your toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps daily.
5. Toe Squeeze Exercise
This exercise is performed in a seated position. Cross the affected foot over the opposite knee. Place a finger between the big and second toe. Then squeeze the toes together to pinch the finger, hold for 5 seconds and relax. Alternatively if you find it difficult to cross your foot over your knee, roll your sock and place it between your big and second toe and with your foot flat on the ground, pinch your sock hold and relax.
Aim to pinch toes together for 5 sec and relax. Aim to build up slowly to 3 x 15reps.
Repeat this exercise once per day.
6. Standing Short Foot Exercise (progression)
Start in a standing position and straighten toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Stand close to a wall or hand rail to aid with balance if required. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps
7. Resistance Band Strengthening Exercise for Toe Extensor Muscles
Start in a seated position. Cross the affected foot over the opposite knee. Then place a resistance band around the top of the foot to pull the toes away from the body so your toes are in an extended position. Hold the band and pull your toes up towards your body against the resistance of the band, then lower them back up to their starting position.
Aim to build to 3 sets of 15 reps
8. Toe Raises
This exercise is performed in a seated position. Place your feet flat on the ground.
Big Toe Raise – Start in a seated position, with feet flat on the floor. Keep your lesser toes touching the floor and lift the big toe. Relax the big toe back to floor. Repeat process 10 times and rest.
Lesser Toe Raises – Keep your big toe touching the floor and lift the other toes. Relax the toes back to floor. Repeat 10 times and rest.
9. Seated Towel Calf Stretch – Knee Straight
Place a towel around the ball of the affected foot and avoid bending your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
10. Seated Towel Calf Stretch – Knee Bent
Place a towel around the ball of the affected foot and bend your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
11. Standing Calf Stretch – Knee Straight
Place your hands on a wall for support and take a step back with the affected foot. Now begin to bend the knee of your front leg whilst moving your chest towards the wall until you feel a stretch in the back of you calf muscle.
Hold for 30 seconds and repeat 3 times.
12. Standing Calf Stretch – Knee Flexed
Adopt the same starting position as you did for the previous exercise. Slide the affected foot towards the front foot as demonstrated. This time when bending the front knee, also bend the knee of the back leg until you feel a stretch deeper in the calf muscle.
Hold this for 30 seconds and repeat 3 times.
