The fifth toe, unlike the fifth column, first born, second coming, third wheel or anything else involving numbers and objects, refers to a congenital malformation that is not only unpleasant to behold, but also an enduring source of discomfort that poses an inability to wear normal shoes.
Defined as the little toe, baby toe or pinky toe, it is always the outermost toe on the foot. Some confusion arises with general definitions because various deformities of the fifth toe are often clumped together into the singular diagnostic category of hammertoe.
Many underestimate the complexity of the fifth toe but our experts at JAWS Podiatry never miss a trick because they are in the business of getting it right all of the time and not just most of the time.
This is due to the fact that surgery on a fifth toe is often a small part of a larger operation that is usually the last procedure performed. It is fair to say it can be considered more like: oh-by-the-way-while-we-were in there type of surgery.
Fifth toe deformities can occur in both men and women during childhood or adolescence. No matter which stage in life they appear, these deformities often require surgical correction.
These conditions are usually asymptomatic and involve: overlapping (aka overriding or overlapping toe) a curly toe or a bunionette deformity. These often cause redness, pain, bursitis and the formation of thick corns.
Congenital deformities of the fifth toe do not require routine laboratory or radiographic evaluation.
X-rays are used to indicate a specific deformity, but a physical examination always provides the most vital tool of assessment.
Our teams will determine the chosen procedure depending on the location of the wound and the degree of pain involved.
The following conditions represent the most common fifth toe deformities that we face every day.
Also known as a crossover or pinky toe or digit quinti varus, this toe is important because it helps maintain balance while standing or moving. Injuries to this toe can be very painful and throw a walking gait off track.
It is believed to be a congenital deformity but it can also arise from wearing shoes that are too tight as well.
In some cases, an overlapping toe will correct itself as children learn to walk. Often aided by strapping and bracing, an overlapping big toe is also known to reappear in many instances once bracing is stopped.
In these instances, the experts at JAWS Podiatry suggest that customized shoe wear is a workable option.
One tried and true surgical procedure for an overlapping toe is known as Derotation Arthoplasty, which can improve the overall appearance and position of the toe. While this time-tested operation can result in floppy toe, the experts at at JAWS Podiatry prevent this from happening with the utilization of a stabilizing poly-L-lactic acid pin.
The deformity can also be corrected by fusing the tendons of the fourth and fifth toe together, which allows the fourth toe to serve as a permanent splint for the fifth one.
Another option is the Butler Procedure, which was developed in Cambridge, England, and can be likened to changing the gears on any machine.
It involves a complete realignment of the entire toe. It is simple and safe with no need for immobilization.
The process requires a racquet-shaped incision, which both allows the toe to rest in its anatomically correct position and encircles the base of the fifth toe.
A second incision is made on the plantar aspect (that part of the foot contacting the ground), which will permit lateral alignment with the remaining toes.
Also known as an underlapping or underriding toe, this malformation is present at birth is characterized as a condition in which there is a visible curling of one or more toes under an adjacent toe.
It most often occurs on the small toes of either one or both feet. At this time, experts are uncertain as to what causes this deformity in infants, but it is believed that it may be the result of an unexpected tightness of the flexor tendons that attach underneath the toe and fail to keep it straight.
It can also be a congenital condition that runs in a family. Occasionally, curly toes are caused by some problem concerning the bones rather than the tendons.
This condition often corrects itself as children learn to walk. Shoe modifications can help for initial stages of management after early childhood years.
Non-operative treatments can also include: wearing pads, arch supports or shoe inserts, which serve to cushion the toe. Exercises can also help to stretch the toe muscles.
Women and wannabes, hear this. Avoid high heels always!
Surgical Considerations
The Simple Flexor Tenotomies procedure is minimally invasive and concerns cutting one or both of the tendons (flexor digitorum) underneath the toe.
It provides an alternative to open surgical procedures performed in a standard operating room.
Resection Arthroplasty, which is also known as excision arthroplasty is another safe surgical procedure that entails removing half of a joint under an affected toe so that it can lie flat.
The space that remains fills with scar tissue over time. Drugs numb the area around the toe for this procedure, but the patient is always awake during surgery.
Bunionette Deformity
Also known as a tailor’s bunion, a bunionette appears on the fifth toe metatarsal bone (there are 5 in the foot) at the base of the little toe.
It always occurs at the metatarsal head, which is located at the far end of the bone where it connects with the foot.
They are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.
Its name derives from the tailors of the past century who were known to sit with their legs crossed all day with the outer edge of their feet constantly rubbing against the ground. This often resulted in a painful bump at the base of the pinky toe.
Before surgery is considered, we recommend conservative treatments that include: wearing wide shoes, specialized orthotics devices; anti-inflammatory, non-steroidal drugs and forfeit barrier pads.
When home remedies fail, the proper surgical intervention is determined by the severity and grade level of the bunionette.
Grade 1 entails a re-sectioning of the round bump on a bone where it forms a joint with another bone (lateral condyle) and capsule plication, which refers to the cutting of the joint capsules located on the top and bottom of the buckled toe, which help to preserve both the metatarsal length and joint mobility.
For more severe bunionettes, a Distal Metatarsal Osteotomy is encouraged. The term, osteotomy, is used whenever a surgeon cuts into and repositions a bone. In this procedure, the far end of the bone is cut and moved outwards.
This serves to reduce the divergence between the first and second metatarsal bones. Usually, one or two small incisions into the foot are required.
When the positioning of the bones is satisfactory to the surgeon, metal pins will hold the osteotomy securely in place, where it will remain unto the bone heals (usually between 3 to 6 weeks after surgery).
We are a cutting edge lower extremity center created by Dr. Abraham Wagner, South Florida’s top-rated and highly acclaimed Doctor of Podiatric Medicine (DPM).
Situated in Hollywood, Florida, he and his dedicated staff are experts in all inclusive foot and ankle care servicing patients living in Miami-Dade, Broward and counties beyond.
We are well known for many good things; not the least of which is passion and a powerful sense of family and commitment to superior service.
Our many offerings include but are not limited to: podiatric care, treatment and therapy, foot and ankle surgical procedures; regenerative medicine and platelet rich plasma therapy (PRP).
Each and every patient that crosses their threshold is special and worthy of individualized attention.
We understand and are always challenged by what they can learn from the fact that no two feet are ever exactly alike. Surgery is always a last resort and minimally invasive techniques (MIS) are always suggested first.
If you live anywhere throughout the United States or beyond and are suffering form unrelenting foot pain, contact our teams today and be pain free tomorrow.
SCHEDULE APPOINTMENTSurgically correcting this deformity with a de-rotation of the toe can successfully improve the appearance and position of the toe. When the toe is rigidly contracted with a sharp bone spur or inflamed bursal sac, the toe becomes fat, painful and interferes with shoe wear. Aesthetic correction of toe can be performed to reduce the deformity and relieve the symptoms.
Because no two feet are alike, each patient deserves individualized attention and a procedure geared towards their specific situation and goals may be proposed.
