The four middle phalanges of the toes (absent in the great toe) provide the connection between the proximal and distal phalanges, and are the primary site of hammer toe deformity when the flexor tendons become chronically contracted.
| Articulations |
|
|---|---|
| Landmarks |
|
| Ossification | Endochondral ossification with proximal epiphyses. |
Middle foot phalanges are present in toes 2 through 5 only (the great toe lacks a middle phalanx). Hammer toe deformity produces fixed PIP flexion contracture of the middle phalanx on the proximal phalanx, causing painful dorsal pressure at the PIP joint from shoe friction. Surgical correction involves resection arthroplasty or arthrodesis of the PIP joint.
Fractures of the lesser toe middle phalanges from stubbing are managed with buddy strapping and stiff-soled shoes.
Fixed flexion at the proximal interphalangeal joint causes the middle phalanx to point downward and a painful corn over the joint.
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