Now accepting Telehealth appointments. Schedule a virtual visit.

The lesser Toes

Lesser toe deformities and pain are among the commonest problems presenting to a foot and ankle team. Many can be treated by accommodation and symptomatic control. However, many patients can only be made comfortable by surgical relaignment of their toes.

What use are the lesser toes?

In other primates the toes can be used for gripping. A few humans have learned to do this when hands are unavailable. However, for most humans the main function of the toes is to enlarge the contact area of the forefoot in the late stance phase of gait. The lesser toes take little pressure in standing, but in walking take about 80% of the pressure under their own metatarsal head.

The great toe takes the highest pressures (30% of total toe pressure), with the second taking 25%, the third 20%, the fourth 15% and the fifth 10%. (Hughes et al 1990).

To do this, the most important requirements are stability and co-ordination with the rest of the foot. These are achieved mainly through the plantar fascia; the intrinsic and extrinsic muscles are not active at this stage of gait.

Muscle imbalance can, however, lead to toe deformity. Loss of the plantar fascial control through degenerative plantar plate tears is a much more common problem than is commonly thought. Pressure on the toes from ill-fitting shoes is important in many patients, especially when the second toe is long. Congenital deformities and post-traumatic deformities can also lead to pain and pressure.

There is relatively little good-quality research into the biomechanics, pathology and treatment of lesser toe problems. It is therefore more difficult than usual to give clear evidence-based recommendations for treatment. I’ll try to distinguish between explanations and advice based on evidence – and what simply seems reasonable (and awaits your research opportunities!)

To understand what goes wrong with the lesser toes it is important to grasp their anatomy and, particularly, how the plantar fascia and, to a lesser extent, muscle action control and stabilise the toes.

You Might Also Enjoy...

Your feet and the Right Running Shoe

Over the past few years there has been a trend in the running world toward minimalistic shoes. A minimalistic shoe is defined as a shoe that allows the foot to function as close to its natural state as possible. They are generally manufactured with less...

What are Flat Feet?

Having flat feet means having a feet that don’t have a proper arch. Flat feet are a common problem that affects pediatric, adult, and geriatric patients alike. There are three different types of flat foot: Flexible Flat Foot. This is the most common...

Everything you wanted to know about Bunions

Bunion Basics A bunion is a painful bump near the big toe. Wearing tight-fitting, high-heeled shoes does not cause bunions, but it sure can aggravate them. Learn more. If you notice a bump not far from your big toe that is red and throbbing, you’ve...

If you smoke it can hurt your feet…

Smoking doesn’t just harm your lungs and your heart. It is also a major risk factor for a condition that harms millions of Americans’ feet. You’ve likely read how smoking can cause lung cancer and heart disease. Now it’s time to read about what smoking...

What Causes Ingrown Toenails?

What Causes Ingrown Toenails? Toenails that curve over and dig into the skin of your toe are called ingrown toenails. They can cause significant pain, but are generally not serious if taken care of. If you don’t take good care of your feet though, an...

Our Locations

Choose your preferred location