Lesser-toe deformity.

Area of Science:

• Orthopedics
• Podiatry
• Foot and Ankle Surgery

Background:

• Lesser-toe deformities are common and functionally impairing, particularly in elderly individuals, increasing fall risk and reducing autonomy.
• These deformities often stem from imbalances in foot musculature or failures of capsuloligamentous structures.

Purpose of the Study:

• To provide an updated overview of lesser-toe deformity management.
• To address key questions regarding anatomy, pathophysiology, analysis, classification, and treatment strategies.

Main Methods:

• Review of current literature and expert opinion (Level of Evidence V).
• Discussion of diagnostic approaches including cause, site, reducibility, and joint stability assessment.
• Presentation of a new classification system by the French Foot Surgery Association (AFCP) for standardized descriptions.

Main Results:

• Acquired deformities result from intrinsic/extrinsic muscle imbalance or stabilizer failure.
• A validated AFCP classification provides standardized, reproducible morphologic descriptions.
• Treatment options range from conservative (footwear, physiotherapy) to surgical (soft tissue, bone, joint procedures).

Conclusions:

• Management must be etiology-specific.
• Treatment progresses from conservative measures to surgical options, with surgery often performed sequentially.
• Decision-making is aided by provided treatment algorithms.