The fifht supraductus toe. Basic concepts

The fifth supraductus toe shows the alteration of the anatomical position of such toe. Its main characteristic is a curvature of the fifth toe in adduction, external rotation and hyperextension putting such toe on the fourth toe (this fact gives it an applanated aspect). It is about a congenital anomaly by congenital morphologic alterations or by a supernumerary sesamoid. It can be showed in a unilateral or bilateral way and it affects the two genders in a similar way.It shows a subluxation of the metatarsophalangeal joint and a retraction of the extensor tendon, tensing in an arch way the extensor and flexor tendons. This will cause a displacement from the head of the fifth metatarsal to the plantar zone and a raising of the proximal phalanx to the supraductus position.

This position of the fifth toe over the fourth toe can cause lesions or hyperkeratosis (callus) in the plantar and lateral zone as a consequence of a continued friction of the fifth toe with the shoe.

The metatarsophalangeal joint of the fifth radius is different from central metatarsals by a bigger articular movement, as for instance, in pronation or supination. Its main task is to stabilize the foot in the lateral position, because the contact of the styloid process against the ground concentrates the body burden on the base and not in the head. The conservative treatment through bandages and orthesis with a corrective purpose is ineffectual, so the use of these treatments together with appropriate shoes will be addressed to mitigate the possible inconveniences in case there would be some of them.

The surgical treatment is appropriate in the case that the patient has a serious pain. In these cases the pain is usually accompanied by a stiffness of the fifth toe so this causes mechanical traumatisms with shoes. The surgical treatment through a minimum incision is usually very satisfactory because it allows an immediate and a little disabling wandering around.

The most commom surgical treatment provides the making of a dorsal Z-plasty, a dorsal capsulotomy of the metatarsophalangeal joint and a tenotomy of the extensor of the toe.