Digital deformities are very common in both children and adults. The most common types of digital deformities are hammertoes, underlapping toes, and rotated toes. Some of these conditions are congenital but they can also develop with trauma or poor foot posture.
Congenital deformities, or problems that occur at birth, are typically a result of poor positioning of the feet in the womb. When feet are in a tight space for a long period of time during development the probability of developing a deformity is very high. Luckily when children are born there bones are not mature and therefore very flexible. Strapping and bracing can help to straighten out any deformities if applied correctly and consistently.
In adults these congenital deformities may not cause a problem until later on in life. The lifelong deformity may only become symptomatic in certain shoes or during specific activities. These problems will be identified through physical examination and appropriate radiographic studies.
Hammertoes or contracted digits are quite common among all age groups. The most common cause of hammertoes is a compensatory movement called flexor stabilization. Flexor stabilization is when the toes contract hard against the ground in order to gain stability for poor foot posture. The contracture of the toes can lead to painful calluses on the tops and tips of the toes. Also, nail deformities can occur since the nail is repeatedly hit against the ground.
Overlapping/underlapping toes can occur as a result of a birth defect but also trauma. When we stub our toes on the bed post fractures commonly occur. These fractures may not heal in a rectus fashion. If the bones heal crooked then under/over lapping toe deformities occur.
Dislocation of a toe joint secondary to trauma can also cause this deformity to happen. Rotation of the 5th toe is also a very common digital deformity. This deformity usually occurs because of external pressure caused by poor fitting shoe gear. The chronic trauma of tight shoes can force the toe into a rotated position. This rotated toe can be irritated with rubbing against inside of the shoe. Callus may also develop due to the chronic friction.
To treat all these deformities is usually quite simple. Orthotic or custom inserts help to align the foot into a proper posture so that the toes do not have to compensate with contracting of the digits. The orthotics also help to keep the toes aligned by supporting the foot completely.
Strapping and padding to the toes can help to realign the toes in a more rectus position. If the strapping and padding are applied consistently enough the body may conform to the new position. Physical therapy to help stretch tendons and ligaments may help in attempting to correct digital deformities. If the deformities are severe enough then surgery may be considered. Tendon release can achieve a straight toe by eliminating tight tendons. When the tendons of the toes are too tight they cause the toe to bend too much thus resulting in a deformity. Bone surgery is only required if the deformity is rigid and the pain is severe enough.