Performed by – David Hinsley, Ngwe Phyo, Nick Ward

Curling of the lesser toes is quite common and may lead to a hammer toe or claw toe deformity. There are numerous causes as to why the toes may slowly and progressively develop such deformities, but essentially there is an imbalance between the pull of the extensor tendons, (on the top of the toe) and the flexor tendons (underneath the toe). Once the toe becomes deformed it can become uncomfortable in shoes as the knuckle can become prominent and then rub. Sometimes the tip of the toe may curl downwards instead of pointing forwards, which is also uncomfortable.

Most of the time they can be managed conservatively by modifying footwear or applying padding to the toe, but occasionally they require surgery to correct the deformity and relieve pain. The procedure usually involves a combination of tendon lengthening, or transfer, and a bony procedure to either fuse some of the small joints within the toe, or excise a joint.

A wire may be passed down the toe to hold the bones straight while the joints “knit”. This will be left in situ for 6 weeks, with a small portion extending from the end of the toe. The toe will need to be kept clean and dry for this time, before the wire is pulled out in clinic. Steri-strips (butterfly stitches) may be applied to the toe to assist in keeping it straight.

Post-operative rehabilitation
Steri-strips and sutures and are removed after 14 days. If taping was required, patients will be taught how to do this and will need to continue this daily for 6 weeks. Patients may weight bear as tolerated in post-operative shoes, but should elevate the foot for the first 24 Hours. Ankle exercises are encouraged, but you should not attempt to wiggle your toes. The aim is to wear a normal shoe after 6 weeks.

Bilateral Lesser Toe Deformities