Listed below is a brief overview of several toe deformities that occur in children.
Bunion (Hallux Valgus)
A bunion (hallux valgus) is a common toe deformity where the big toe shifts laterally over the second toe. The first metatarsal bone shifts inwards and causes a prominence over the medial aspect of the metatarso-phalangeal (MTP) joint. A fluid filled sac (bursa) may form over this prominence and result in continuous irritation and inflammation. Flat feet are also sometimes associated with this condition.
Bunions are believed to be caused by a hereditary structural foot anomaly or wearing narrow shoes that curl or fold the toes. Most children with bunions do not have any symptoms and typically do not require treatment. However, your child’s doctor may recommend shoes that have a good amount of space for the toes and no heels. If there is a flat foot, a shoe insert may help to prevent its progression. Surgery is only recommended for very severe cases.
Bunionette (Tailor Bunion)
Bunionette is a less common toe deformity that occurs when a fluid sac develops over the lateral side of the fifth metatarso-phalangeal (MTP) joint and becomes prominent and inflamed. The pain and discomfort can typically be relieved with padding in most cases and surgical correction in rare severe cases.
Claw toe is a rare deformity that affects all of the toe joints and results from hyperextension of the MTP joints and flexion of the proximal inter-phalangeal (PIP) and distal inter-phalangeal (DIP) joints. Claw toe results from an altered structural anatomy and /or neurological disorder that causes muscle imbalances and occurs in association with cavus foot, myelomeningocele, and Charcot-Marie-Tooth disease.
Curly toe describes a condition where the tendon that runs below a toe is tight and pulls the tip of the toe under towards the sole of the foot. The condition is present at birth and can affect the third, fourth, and fifth toes of one or both feet. Children may develop areas of hard skin on the sole of the foot and have difficulty selecting shoes that fit properly and comfortably. Treatment, in the form of a tendon release procedure is typically only required if the condition becomes severe and causes irritation.
Hammertoe is a deformity in which there is downward bending of the proximal inter-phalangeal (PIP). The condition can affect any toe but most commonly affects the second toe. It may be present at birth or result from wearing shoes that are too tight and force the toe to bend forward. It causes no pain and does not require any specific treatment. Hammertoe can be prevented / treated by ensuring that children wear well fitting shoes that have enough space for the toes to stretch out comfortably.
Mallet toe refers to the downward bending of the distal inter-phalangeal (DIP) joint which results in a mallet-like appearance. Corns or calluses may develop over the deformity as a result of constant friction caused by footwear. Mallet toe can be inherited or may develop from wearing shoes that are too tight or high-heeled.
Polydactyly describes a condition where a foot has an extra digit which usually affects the big toe or pinky (fifth) toe. Surgical excision of the extra digit is typically only required in cases where the extra digit is prominent and makes it difficult to wear shoes. The procedure is usually performed after the age of 9 – 12 months.
Syndactyly refers to a condition where he digits are fused; it rarely causes any problems and does not need require treatment. The connection between the toes can vary from a thin skin attachment to a bony attachment (synostosis) between the phalanges.