Lesser Toes Proximal Interphalangeal Joint Fusion in Rigid Claw Toes C. Sergio Fernández, MD a, *, Emilio Wagner, MD b , Cristian Ortiz, MD b INTRODUCTION Lesser toe deformities are a common complaint (more than 20% of office requests) 1 and should not be considered a minor problem because pain and deformity can have a significant impact on the patient’s quality of life. Moreover, a common language and common definitions of every deformity are lack- ing, 2 and this misunderstanding precludes comparable results among different publi- cations. For the purposes of this discussion, hammertoes are defined as flexion of the proximal interphalangeal joint (PIPJ) with or without interphalangeal joint deformity. 3 NONSURGICAL TREATMENT Nonsurgical treatment is the first approach for most patients. It should include a recommendation to wear shoes with wide toe boxes and avoid high heels. Some devices are available off the shelf, including padding for painful calluses, silicone gel pads, and different kinds of strapping devices. Periodic trimming is also helpful, but none of these options produces a permanent correction. If the patient is not satisfied with nonsurgical treatment, surgical options can be recommended. a Foot & Ankle, Clinica Santa Maria, La Gioconda 4344 Dpto 201, Las Condes, Santiago 6761703, Chile; b Clinica Alemana, Universidad del Desarrollo, Las Condes, Vitacura 5951, Santiago, Chile * Corresponding author. E-mail address: fernandez.sc@gmail.com KEYWORDS  Rigid claw toes  Proximal interphalangeal joint  Lesser toe  Deformities  PIPJ KEY POINTS  Nonsurgical treatments should always be explored before considering surgical intervention.  In most cases, hallux valgus deformity must be corrected to prevent recurrence of toe deformity.  Arthrodesis of the lesser toes is the most common procedure to correct the proximal interphalangeal joint deformity. Foot Ankle Clin N Am 17 (2012) 473–480 http://dx.doi.org/10.1016/j.fcl.2012.07.004 foot.theclinics.com 1083-7515/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.