Toe Problems

Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.

Toe deformities in adults result mainly from an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities. Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly fitting footwear, or if a fractured toe heals in a poor position.

The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, and overlapping and underlapping toes.

Intoeing and out-toeing occur when the feet are positioned too far inward or outward when walking. Both conditions may be observed in young children as they are learning to walk. By the age of two, most children outgrow these problems on their own. Beyond this age, verbal reminders and reassurance may be advised to make the child aware of the proper position of the foot. In persistent cases, children may be required to wear special shoes or foot supports to help train them to place their feet in the right position. These interventions are designed to reduce abnormal pressures on the foot structure and function while still in their formative development.

Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most commonly affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes they can be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straightened position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.

Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes). The cause of underlapping toes is unknown. It is speculated that they may be caused by an imbalance in muscle strength of the small muscles of the foot.  If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe.

Subungual exostosis is more commonly referred to as a bone spur under the toenail. This condition is generally caused by toe trauma, which results in the formation of a bony irregularity or prominence. The normal treatment for subungual exostosis is surgical removal. Other small tumors, called osteochondromas and enchondromas, can also form in the bone beneath the toenail.

Big toe injuries, known as turf toe, result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the big toe, and the soft tissue structures that support the big toe on the top are torn or ruptured.

Turf toe often arises from participation in team sports. Symptoms include pain, tenderness, and swelling of the toe joint. There is often a sudden acute onset of pain during a push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and can dramatically increase the healing time required.

Treatment includes rest, icing, compression, and equipment modification or change. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Note: Please consult your physician before taking any medications.