II. Definition

  1. Flexion deformity at proximal interphalangeal joint
  2. Results in depressed tip of toe deformity

III. Etiology

  1. Improperly fitted shoes

IV. Signs

  1. Metatarsal-phalangeal joint (MTP) mild hyperextension
  2. Interphalangeal joint (ITP) flexion deformity
  3. Second toe involvement most common
    1. Especially with second toes longer than great toe
  4. Associated with Hallux Valgus deformity at great toe
  5. Corns or Plantar Callus locations
    1. Distal toe
    2. Dorsum of proximal Interphalangeal joint (ITP)
    3. Beneath Metatarsal heads

V. Management

  1. Mild flexible deformity
    1. StretchingExercises
    2. Over and Under taping to adjacent toes
    3. Toe cap or Crest pad (2 inch cotton dental roll)
      1. Position under second and third toes
    4. Gell-filled corn pad over interphalangeal joint
    5. Properly fitting shoes
  2. Resistant cases of fixed deformity
    1. Surgical correction
    2. Percutaneous flexor tenotomy
      1. Office procedure with small stab incision to the plantar surface (between MTP and PIP)
      2. Lountzis (2007) Wounds 19(3):64-8 [PubMed]

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