toe deformities

The foot is roughly divided into three sections: the rearfoot or heel, the midfoot and the forefoot & toes.

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. The 14 bones of the toes are among the smallest in the body, and, not surprisingly, things can and often do go wrong. Some problems begin in childhood and may go unnoticed. Others begin later on in life, perhaps as the result of injury or the added pressure of incorrect footwear.

What are bunions?

What most people call a bunion is actually known as "Hallux valgus". Hallux valgus refers to the condition in which the big toe is angled excessively towards the second toe – and a bunion is a symptom of the deformity.

In a normal foot, the big toe and the long bone that leads up to it (the first metatarsal) are in a straight line. However, Hallux valgus occurs when the long foot bone veers towards your other foot and your big toes drifts towards your second toe.”

A bunion actually refers to the bony prominence on the side of the big toe. This can also form a large sac of fluid, known as a bursa, which can then become inflamed and sore.

Is it serious?

Some people have massive bunions that aren’t that painful but cause difficulties with shoes, while others have relatively small bunions that are very painful. However, just because you have Hallux valgus doesn’t mean you’ll get the bursa.

Pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. Likewise, if the second toe and big toe cross over, it can be difficult to walk.

Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse.

This condition can also encourage corns and calluses to develop.

Who gets them?

Women tend to get bunions more than men. This could be due to the more restrictive footwear they wear, (such as high heels or narrow toe boxes which force the big toe towards the little toes) but women also tend to have looser ligaments, making them slightly more prone to bunions. You’re also more likely to get bunions if your parents or grandparents have them.

What causes bunions?

There are a number of causes, and though shoes can exacerbate the problem, bunions do occur in societies that don’t wear them.

Such problems can be exacerbated by tight footwear. Slip-on shoes can make matters worse, because they have to be tighter to stay on your feet, you automatically have less room for your toes. And with nothing to hold your foot in place, your toes often slide to the end where they’re exposed to lots of pressure. Likewise, high heels throw more weight onto the ball of the foot, putting your toes under further pressure.

If you haven’t got a bunion by adulthood and you later develop one, there could be some underlying arthritis.

What can I do?

One of the best things you can do is to go for wider, deeper shoes. There should be a centimeter between the end of your longest toe and end of shoe. You should also choose shoes with an adjustable strap or lace.

Podiatrists often recommend exercises to strengthen your muscles and tendons around the big toe.

What can a podiatrist do?

Your podiatrist can recommend exercises, orthoses (special devices inserted into shoes) or shoe alterations.

Your podiatrist can advice you on your options.

Other Big Toe deformities

A complaint which is more common among men then women is "Hallux rigidus", where, instead of bending normally, the big toe stiffens and forms a bump at the top of the joint, making the 'pushing-off' motion in walking difficult. This often results from stubbing or injury to the toe, perhaps during sport. Women often suffer from "Hallux rigidus" as a result of persistent trauma to the joints from slip-on or shoes that are too tight.

Wearing shoes with low heels and firm soles will act as a supporting splint. Podiatrists will be able to provide pads or strapping to stabilise the joint, or appliances (orthotics) to modify the way you walk. In severe cases, footwear may be modified or surgery may be indicated.

Smaller Toes

Another common complaint is "Hammer Toes". The toe most usually affected is the second, which becomes bent up in an inverted "V" shape and can't straighten out during walking. Corns develop where it rubs against the shoe. Some people are born with clawing of the lesser toes, which might be due to muscle imbalance, and can lead to hammer toes. Too-tight shoes and socks make the condition worse.

Podiatrists will be able to prescribe treatment, appliances which straighten the toes, or, when necessary, may advise surgery to provide permanent correction.

Curly/ Retracted Toes

Many babies are born with toes that don't lie flat, or are retracted. The problem generally clears up, especially if the toes are not too restricted in the early stages by tight shoes and socks. If the problem continues, muscle strengthening exercises may help, or silicone orthoses may be needed to correct the complaint.