Lesser Toe Deformities

Abstract

The lesser toes deformities in pediatric is most common alteration into the disturbance of the foot and can be divided in soft tissue imbalance which cause mainly curly toes, hammer, claw, and overlapping toes (tendon imbalance and capsule contraction) with the main feature that can be reduced temporally by the explorer during physical examination. On the another hand, congenital deformities as macrodactyly and polydactyly additionally have disturbance of the bone tissue.

Lesser toes can present asymptomatic deformities of parental concern; sometimes these deformities may be painful and disabling. The diagnosis starts with a diligent general physical examination. In these patients, we should be alert due to syndromic association. Imaging evaluation is considered when bony connections are suspicious, usually indicated around the first year of age to allow nuclei of ossifications nucleus to appear. Most of the time, radiographic AP and lateral are enough to decide a plan. However, we do not rule advanced studies for more complex deformities.

When just the soft tissue is involved, nonoperative option through strapping, splinting, and shoe modification would be reasonable first line of treatment. Sometimes those are insufficient, and the correction requires surgical procedures as tenotomy, capsulotomy, tendon transfers, etc. In case bone and soft tissue are involved, aggressive treatment is necessary as partial resection, reduction (shortening), or even amputation. High risk of relapse is observed in this group of patients; for that reason close follow-up is recommended.

Overall, the goal of the treatment is to obtain a pain-free toes with acceptable appearance and improve the function.