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Phalanges of the Foot (Overview)

phalanges pedis

The 14 foot phalanges include proximal, middle, and distal phalanges for the lesser four toes and proximal and distal phalanges for the great toe. The phalangeal joints (MTP, PIP, DIP) are sites of hammer toe, mallet toe, and claw toe deformities. The distal phalanges of the great toe develop sesamoiditis and subungual exostosis. The proximal phalanx of the great toe is the site of Akin osteotomy for hallux valgus with proximal phalangeal valgus.

Anatomical Data

Structure & Landmarks

Articulations	MTP joints (proximal phalanges with metatarsal heads) PIP joints (proximal and middle phalanges in lesser toes) DIP joints (middle and distal phalanges in lesser toes) IP joint of the great toe (proximal and distal phalanges)
Landmarks	Great toe distal phalanx (subungual exostosis and sesamoiditis location) Fifth toe PIP (most common site of hammer toe requiring correction)
Ossification	Primary phalangeal centres at 9-12 weeks fetal. Epiphyses appear at 4-8 years and fuse at 18 years.

Clinical Relevance

Clinical Notes

Hammer toe (PIP flexion contracture) is corrected by FDS tenotomy for flexible and PIP arthroplasty or fusion for rigid deformities. The Weil osteotomy (oblique metatarsal shortening) is the definitive procedure for MTP joint subluxation with floating toe deformity.

Pathology

Common Injuries & Conditions

Toe Fracture

Stubbing or crush injuries fracture the phalanges and are usually treated with buddy strapping.

Lesser Toe Deformities

Hammer, claw, and mallet toe deformities alter phalangeal alignment and cause painful corns.

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