A sagittal plane deformity of the toe where the DIPJ is in a flexed position, the PIPJ is in a neutral or extended position and the MTPJ is neutral or dorsiflexed. Usually only one toe – maybe bilateral.
Inappropriate footwear – narrow toe box, inadequate dept of toe box, too short, too small; Familial predisposition/inherited factors; Neuromuscular disorders; Long digit (plantarflexion occurs at IPJ due to shoe pressure); Ineffective flexor digitorum brevis (when flexor digitorum longus contract, the distal phalanx will plantarflex).
Many are asymptomatic; pressure from footwear may cause bursal development over the DIPJ- maybe a fistula and sinus; may be hyperkeratotic lesions associated with the pressure on DIPJ and apex of joint; nail dystrophy is common; may be pain secondary to arthritic changes; early, range of motion is normal, but later limited dorsiflexion at DIPJ.
Treat inflammatory states and reduce hyperatotic lesions.
Protective padding if fixed.
Corrective padding or splints if flexible
Surgery (flexor tenotomy; resection of head of middle phalanx; partial amputation; arthrodesis of IPJ)