Starting Position
The joints of the lesser toes include a metatarophalangeal, a proximal interphalangeal, and a distal interphalangeal joint for each toe. These joints allow for flexion and extension of the lesser toes. Range of motion of these joints can be assessed with the patient seated or in the prone position. The examiner stabilizes the proximal portion of the joint (foot, proximal phalanx, middle phalanx) with one hand while grasping the distal portion of the joint with the other hand. To assess extension the examiner should move the toe cephalad (toward the patient’s head). To assess flexion the examiner should move the toe caudally (away from the patient’s head).
Ending position
Normal passive range of motion of the metatarsophalangeal joints is 40° of extension and 40° of felxion. Normal passive range of motion of the proximal interphalangeal is 0° of extension and 35° of flexion. Normal passive range of motion of the distal interphalangeal joints is 30° of extension and 60° of flexion.
Clinical Significance
Decreased range of motion at these joints may be the result of an intraarticular fracture, mallet toe, claw toe, or hammer toe.
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