Typical lesser toe symptoms. Pressure symptoms indicate not enough room in toe box of shoe
Lateral toe crowding symptoms indicate shoe too narrow
It's important to establish exactly what the patient is complaining of. The commonest complaints are pressure over deformed toes, MTP pain and metatarsalgia.
Find out what remedies have been tried. How much has the patient tried to adapt what shoes they wear. Some people only get problems when they wear safety boots, and have been told by work to get their toes fixed - in fact, accommodative safety boots can be provided by the orthotist.
Some people have little or no trouble now, but are concerned they may get trouble in the future and should get their toes straightened now "in case it's too late" (answer: almost always "no"). Others have no trouble but don't like the look of their toes (don't!).
Is there an underlying condition? Always ask about:
- trauma
- inflammatory arthritis
- diabetes, especially with neuropathy
- neurological disease, especially Charcot-Marie-Tooth disease, polio and spinal problems
- family history of neurological disease or foot deformity
- vascular disease
- any other deformity suggesing a malformation syndrome
Ask about factors which may suggest a high risk of serious problems and may indicate more aggressive management:
- diabetic neuropathy
- vascular disease
- features suggestive of infection - redness, swelling, constant pain, discharge