Conditions that deform the shape of the four smaller toes, leaving them in a curved position

Aetiology

• Occur due to acquired imbalance between the flexor and extensor tendons
• Claw toes have hyperextension at the MTPJ with flexion at the PIPJ and DIPJ
• Hammer toes have PIPJ flexion, DIPJ extension and neutral MTPJ

Clinical features

• Claw and hammer toes can be painful and can rub on footwear causing corns and skin breakdown

Management

• Toe 'sleeves' and corn plasters can prevent skin problems
• Surgical solutions include tenotomy (division of an overactive tendon), tendon transfer, arthrodesis (PIPJ) or toe amputation