The extensor hood of the lesser toes mirrors the finger extensor expansion, with the EDL providing the central slip and the intrinsics (lumbricals and interossei) contributing lateral bands. The intrinsic minus pattern from neuropathy (diabetes) produces MTP hyperextension and IP flexion (hammer toe) from EDL dominance over the paralysed intrinsics.
Coordinated MTP and IP joint extension through the intrinsic and extrinsic extensor tendons
The extensor hood balance is disrupted in rheumatoid arthritis — synovitis at the MTP joint stretches the plantar plate and intrinsic tendons, allowing the metatarsal head to plantarflex through the plantar plate while the toes cock dorsally. The resulting MTP subluxation and cock-up toe deformity requires MTP synovectomy and soft tissue rebalancing.
Extensor hood disruption from rheumatoid synovitis producing cock-up toe and MTP dislocation managed with synovectomy and plantar plate repair.
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