A, Normal alignment and balance of metatarsophalangeal joints and toes. B, As rheumatoid deformity progresses, imbalance occurs with progressive dorsal subluxation of metatarsophalangeal joint and deformity of lesser toes. C, End-stage deformity with dislocation of metatarsophalangeal joint and proximal phalanx ankylosed to dorsal aspect of metatarsal head. D, Severe claw toe deformity in right foot of patient with rheumatoid arthritis; left foot has been surgically corrected.