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The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature. | LitMetric

AI Article Synopsis

  • Forefoot disorders affect 2-20% of the population, with lesser toe deformities (like hammer, claw, and mallet toes) being common, often treated conservatively before considering surgery.
  • Effective conservative treatments include shoe modifications (like rocker soles and wide toe boxes) and orthoses, which can alleviate symptoms but should be tailored to individual needs, emphasizing patient education.
  • Although these methods can provide relief, they are not permanent fixes, and are typically more suitable for older patients or those with lower activity levels, as psychological acceptance of orthotic devices can be a significant hurdle.

Article Abstract

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5 mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.

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Source
http://dx.doi.org/10.1007/s12306-024-00871-9DOI Listing

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