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The aim of this article was to discuss the basic anatomy of the lesser toes and the pathology of some of the more common deformities.
Current treatment strategies for management of these deformities were also discussed by the authors.
The metatarsal (MT) heads take a significant proportion of the bodyweight during gait, particularly the first, second and third MTs.
The lesser toes increase the surface area for weightbearing and share the load with the MT heads; this can only occur if the toes remain in contact with the ground during gait.
Deformities of the lesser toes often occur gradually, though they can be brought on by trauma. Ill-fitting or high-heeled footwear is often implicated in the causation of deformity.
Hallux valgus can contribute to the formation and propagation of lesser toe deformities as effective shortening of the first ray may slacken the plantar fascia and weaken the windlass effect on the first toe.
This in turn leads to greater strain on the lesser toes, which makes their supporting structures more likely to fail.
Pathology can also be linked to inflammatory arthritis, synovitis, diabetes mellitus and neuromuscular disorders.
The main adult sagittal plane deformities consist of claw toes, hammertoes and mallet toes. Axial plane deformities include crossover toes.
With chronic hyperextension of the metatarsophalangeal joint (MTPJ), synovitis may develop in the capsule and the plantar plate may become damaged or stretched.
The deformities should be assessed and note made of any hallux and hindfoot and/or midfoot deformities.
Investigations may include routine blood tests for inflammatory markers and glucose levels.
A significant proportion of patients will respond to non-operative treatment measures which should be tried prior to surgical intervention.
The goal of surgical treatment is to achieve a well-aligned and functional toe, but corrective surgery often results in loss of prehensile function or stiffness.
To reduce the risk of recurrence it is important to understand, and adequately address, the underlying pathology.
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