eMedicine Specialties > Orthopedic Surgery > Foot & Ankle
Fifth-Toe Deformities: Multimedia
Updated: Dec 19, 2008
Multimedia
 | Media file 1: Fifth-toe deformities. Example of a hard corn. They commonly occur on the dorsal lateral aspect of the proximal interphalangeal joint, but they can also occur in the same location over the distal interphalangeal joint. |
 | Media file 2: Fifth-toe deformities. Example of a soft corn deep in the web space. Intrinsic pressure develops between adjacent condyles of the lateral fourth proximal interphalangeal joint abutting the medial fifth distal interphalangeal joint, or the lateral fourth metatarsophalangeal joint abutting the medial fifth proximal interphalangeal joint. The lesions can develop on the skin over the lateral fourth proximal interphalangeal joint, medial fifth distal interphalangeal joint, medial fifth proximal interphalangeal joint, or deep in the web space. |
 | Media file 3: Fifth-toe deformities. This Image and the one below are examples of kissing corns. They are 2 calluses that rub against each other on adjacent toes and are usually painful when squeezed together. |
 | Media file 4: Fifth-toe deformities. Example of a kissing corn. These corns are 2 calluses that rub against each other on adjacent toes and are usually painful when squeezed together. |
 | Media file 5: Fifth-toe deformities. This Image and the one below are further examples of kissing corns. Maceration is often noted in the web space and may contribute to their development. When they occur, other common problems, such as fungal infections or verruca, need to be ruled out. These lesions may develop into ulcerations in the neuropathic population if untreated, as is seen in this case. |
 | Media file 6: Fifth-toe deformities. Example of kissing corns. Maceration is often noted in the web space and may contribute to their development. When they occur, other common problems, such as fungal infections or verruca, need to be excluded. These lesions may develop into ulcerations in the neuropathic population if untreated, as is seen in this case. |
 | Media file 7: Fifth-toe deformities. Example of a hammertoe with a dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint. Note the irritated skin secondary to shoe pressure. |
 | Media file 8: Fifth-toe deformities. This Image and the one below represent an overlapping fifth toe. It is dorsally hyperextended at the metatarsophalangeal joint with a varus rotation and medial deviation onto the top of the fourth digit. Contractures develop dorsomedially at the metatarsophalangeal joint and eventually form in the extensor digitorum longus tendon and the dorsomedial skin overlying the metatarsophalangeal joint. |
 | Media file 9: Fifth-toe deformities. Overlapping fifth toe. It is dorsally hyperextended at the metatarsophalangeal joint with a varus rotation and medial deviation onto the top of the fourth digit. Contractures develop dorsomedially at the metatarsophalangeal joint and eventually form in the extensor digitorum longus tendon and the dorsomedial skin overlying the metatarsophalangeal joint. |
 | Media file 10: Fifth-toe deformities. Images This Image and the one below are examples of an underlapping fifth toe, or curly toe. It is plantarflexed at the metatarsophalangeal joint, rotated into a varus position, and positioned under the fourth digit. A contracture typically occurs at the plantar-medial metatarsophalangeal joint capsule and flexor digitorum longus tendon. |
 | Media file 11: Fifth-toe deformities. Underlapping fifth toe, or curly toe. It is plantarflexed at the metatarsophalangeal joint, rotated into a varus position, and positioned under the fourth digit. A contracture typically occurs at the plantar-medial metatarsophalangeal joint capsule and flexor digitorum longus tendon. |
 | Media file 12: Fifth-toe deformities. This radiograph shows a prominent fifth-toe proximal phalanx medial condyle contacting the base of the proximal phalanx on the fourth toe, creating increased pressure and an interdigital clavi. |
 | Media file 13: Fifth-toe deformities. This radiograph shows the distal phalanx of a varus-rotated fifth toe contacting the proximal phalanx on the fourth toe, creating another area of increased pressure and interdigital clavi. |
 | Media file 14: Fifth-toe deformities. This Image and the following 3 Images demonstrate the surgical course for a severe fifth digit cock-up deformity. Note the dorsal contracture in this preoperative photo. |
 | Media file 15: Fifth-toe deformities. Planned incision with arms for the Z-plasty skin-lengthening flap drawn in. The central arm of the Z-plasty is along the line of skin contracture. |
 | Media file 16: Fifth-toe deformities. Exposure showing a severely contracted extensor digitorum longus tendon. This is lengthened during the procedure. |
 | Media file 17: Fifth-toe deformities. Postoperative photo showing a corrected fifth digit. |
 | Media file 18: Fifth-toe deformities. This Image and the ones that follow demonstrate an operative technique for a painful overlapping fifth-toe deformity. |
 | Media file 19: Fifth-toe deformities. Painful overlapping fifth-toe deformity. |
 | Media file 20: Fifth-toe deformities. When the toe is derotated and plantarflexed into the correct position, the dorsal skin "tents up," showing the exact location of the skin contracture. |
 | Media file 21: Fifth-toe deformities. A Z-plasty is performed in this case to lengthen the contracted skin. Length is achieved along the central arm of the "Z" so it is placed along the line of contracture. Adjunctive procedures such as metatarsophalangeal joint release and extensor digitorum longus tendon lengthening should be performed through the same incision. An alternative to the Z-plasty is a V-Y flap. |
 | Media file 22: Fifth-toe deformities. After rotation of the "Z" flaps and soft tissue release, the toe is reevaluated. The toe is down, and the proximal phalanx is in excellent position, but the distal portion of the toe has a varus rotation at the proximal interphalangeal joint. A proximal interphalangeal joint arthroplasty with derotational skin plasty is then performed to address this portion of the deformity. |
 | Media file 23: Fifth-toe deformities. This Image and the one below were taken 5 days postoperatively with the contractures addressed and the toe in good position. |
 | Media file 24: Fifth-toe deformities. Five days after surgery, the contracture is addressed and the toe is in good position. |
More on Fifth-Toe Deformities |
| Overview: Fifth-Toe Deformities |
| Workup: Fifth-Toe Deformities |
| Treatment: Fifth-Toe Deformities |
 Multimedia: Fifth-Toe Deformities |
| References |
| Further Reading |
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References
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Keywords
fifth-toe deformities, toe deformities, hard corns, heloma durum, helomata durum, soft corns, heloma molles, helomata molle, ainhum, hammertoes, hammer toes, claw toes, overlapping toes, underlapping toes, curly toes, congenital varus toes, cock-up toes, little toe, small toes, kissing corns, epidermal hyperkeratosis, Ruiz-Mora procedure, syndactylization, arthroplasty, Z-plasty, flail toe, dorsiflexion contracture, plantarflexion contracture, capsulotomy, DuVries procedure, skin plasty, pinky toe pain, pinky toe deformity, toe pain, intrac table plantar keratosis, clavus, bunionette, pes cavus
