Deformities of the lesser toes – how should we describe them?

Abstract

Introduction Curly toe, hammer toe, claw toe and mallet toe are all terms that describe specific deformities of the lesser toes. Several definitions have been used to describe each one of the deformities [Boc SF, Martone JD. Varus Toe: a review & case report. J Foot Ankle Surg 1995;34(2):220–2; Bignell J. Curing curly toes. Lancet 1993;342(8865):235; Mizel MS, Yodlowski ML. Disorders of the lesser metatarsophalangeal joints. J Am Acad Orthop Surg 1995;3(3):166–73; Coughlin MJ. Lesser toe abnormalities. Instr Course Lect 2003;52:421–44; Coughlin MJ. Operative repair of the Mallet toe deformity, Foot Ankle Int 1995;16(3):109–16]. Anecdotally, the terms have been used very variably to describe these deformities of the lesser toes. We aim to quantify any variation of understanding of these terms and determine whether the deformities would be better described in terms of their position. Methods Questionnaires were circulated by hand among 24 orthopaedic consultants and 33 registrars in five major teaching hospitals. The participants were asked to draw a schematic diagram of each of the deformities. There was a 90% consultant and 85% registrar return of forms. Results There was a 17% variation (Kappa = 0.66) in consultant replies to curly toe as compared to a 30% variation in registrar replies (Kappa = 0.4). There was also a 12% variation (Kappa = 0.76) in consultant replies to hammer toe as compared to a registrar reply variation of 24% (Kappa = 0.52). There was an 8% variation (Kappa = 0.84) in consultant replies to claw toe, with a registrar variation of 18% (Kappa = 0.64). With regards to mallet toe, there was no consultant variation (Kappa = l), but there was a registrar variation of 8% (Kappa = 0.82). Conclusion There was marked variation in the description of these terms among consultants and more so among registrars where several kappa scores where below the acceptable level of variation of 0.8 [Carletta J. Assessing agreement on classification tasks: the kappa statistic. Comput Linguist 1996;22(2):1–6]. We therefore advocate the use of orthopaedic objective terminology, such as dorsal/plantar deviation and horizontal plane deviation with specific joint involvement, in the description of these deformities of the lesser toes.