- Abnormal flexion of the PIPJ of any lesser toe with DIP extension due to a muscular imbalance.
- May be rigid or flexible and is most commonly found in the second toe of elderly women.
- Patients may complain of pain on wearing shoes and deformity.
- Examination may reveal a positive push up test.
- Investigations are not required for diagnosis, management, or referral.
Conservative measures include
- Patient education.
- Shoe wear advice – avoid totally flat, high, or tight shoes. Trainers are appropriate.
- Silicone / foam toe sleeve.
- Diagnostic uncertainty.
- Chronic pain / disability not responding to conservative management.
- Unable to wear normal shoes.