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Toe problems, Vasilios Pandis, Consultant Orthopaedic Surgeon, Corfu

Minor toe abnormalities are common. Parents often think that a toe abnormality is the reason their child is slow or reluctant to walk. This is never the case. Some toe problems are discussed below.


The second toe quite often lies cocked up above the first and third toes in the podgy infant foot. As the foot becomes thinner with growth and spreads with weight bearing the toe comes to lie in line with the others. Treatment with strapping has no benefit and is unnecessary for something that will get better anyway.


Webbing, partial or complete, between the second and third toes is common. It never causes symptoms but misguided attempts to separate the toes with surgery can cause major problems. The scars following surgery often break down in the sweaty conditions in a shoe. This can give rise to repeated and sometimes serious infections. The fear that the child will be teased rarely occurs because children seldom go far with bare feet. The webbing is not easy to see in an active child. Webbing often runs in families and is seen as a sign of special distinction.


This condition often runs in families. It is due to failure of some of the small muscles in the foot to form, probably because we no longer use our feet to grip onto things unlike our monkey ancestors. Nothing can make a muscle appear if it never formed. Surprisingly these toes seldom cause problems even though they tend to sit under the next toe. Curly toes are never the reason for delayed walking in a child.

If the toe causes no pain there is no need for treatment. Strapping the toe or toe spacers do not correct the deformity. If the toe causes pain it will show as redness of the tip or damage to the nail. A simple operation to cut the tendons to the toe will usually sort the problem though it may take some weeks. The risks of surgery cannot be justified only for cosmetic reasons.


In this condition the fifth toe lies on top of the fourth toe. It looks quite ugly but causes surprisingly little in the way of symptoms. If there are symptoms, treatment is appropriate. Strapping or splints do not work so surgery is needed. There is a very small risk of loosing the toe with surgery. In most cases a satisfactory, though not perfect, result is achieved.


In the adolescent bunions may begin to develop. The most important cause of bunions is inherited but there isn't much you can do about your genes! Shoes are important. Bunions are ten times more common in women than men despite both sexes having the same genes for bunions. Fashion shoes with pointed toes are especially harmful. Don't be conned into thinking that you have to spend a fortune on shoes. Any shoes that fit, including trainers and sandals, are perfectly OK. There is no treatment, other than wearing shoes that fit and possibly barefoot walking, which can prevent bunions from developing. Surgery may eventually become necessary for severe bunions. Operation is best left till adulthood since the bunions tend to recur rapidly if the foot is still growing.


There are several other variations of toes that can cause anxiety. The big toe can be hooked inwards (called metatarsus adductus), curled (called hallux flexus) or pointing upwards (called hallux erectus). Metatarsus adductus has all but disappeared since we stopped lying babies face down in the cot. Some children will actively hook their big toe inwards when standing in bare feet but the toe lies normally in the shoe. They always grow out of it so no treatment is needed. It is the same for hallux flexus and hallux erectus which always disappear in time.


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