Other Popular Names
Who does it affect?
People often blame the common foot deformity claw toe on wearing shoes that squeeze your toes, such as shoes that are too short or high heels. However, claw toe also is often the result of nerve damage caused by diseases like diabetes or alcoholism, which can weaken the muscles in your foot. Having claw toe means your toes "claw," digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time.
- Your toes are bent upward (extension) from the joints at the ball of the foot.
- Your toes are bent downward (flexion) at the middle joints toward the sole of your shoe.
- Sometimes your toes also bend downward at the top joints, curling under the foot.
- Corns may develop over the top of the toe or under the ball of the foot.
If you have symptoms of a claw toe, see a consultant for evaluation. You may need certain tests to rule out neurological disorders that can weaken your foot muscles, creating imbalances that bend your toes. Trauma and inflammation can also cause claw toe deformity.
Claw toe deformities are usually flexible at first, but they harden into place over time. If you have claw toe in early stages, your consultant may recommend a splint or tape to hold your toes in correct position. Additional advice:
- Wear shoes with soft, roomy toe boxes and avoid tight shoes and high-heels.
- Use your hands to stretch your toes and toe joints toward their normal positions.
- Exercise your toes by using them to pick up marbles or crumple a towel laid flat on the floor.
If you have claw toe in later stages and your toes are fixed in position:
- A special pad can redistribute your weight and relieve pressure on the ball of your foot.
- Try special "in depth" shoes that have an extra 3/8" depth in the toe box.
- Ask a shoe repair shop to stretch a small pocket in the toe box to accommodate the deformity.
Surgery is occasionally recommended to correct claw toes that cannot be successfully treated non-operatively. There are a variety of procedures that have been described, and often a combination of procedures is performed. Because the deformity occurs as a result of a muscle imbalance, tendon transfer or lengthening may be needed in order to enact a long-term correction and minimize the risk of a recurrence. Common procedures that may be used in combination with others include:
- Straightening the Toe (Proximal Interphalangeal (PIP) joint resection). If there is a fixed deformity at the PIP joint (the first “knuckle” of the toe), this joint can be removed, or repositioned in a straightened position and then fused with some type of fixation, often a wire insert through the toe. This joint may not fully heal with bone, but even a fibrous union (scar tissue) in a straight position will be effective.
- MTP joint (joint at the base of the toe) soft tissue release (capsulorraphy/capsulotomy). Because the MTP joint flexes up, the top part of the joint capsule (soft tissue) becomes very stiff and contracted. It is often necessary to release this, in order for the joint to fall back into the normal position. The MTP joint is held with a temporary wire in the new “straighter” position.
- Extensor tendon lengthening. Often the tendons that pull the toe upwards (long extensor tendons originating from the extensor digitorum longus muscle) will become contracted and tight. These tendons can be lengthened to allow the toes to fall back into an improved position.
- Flexor to extensor tendon transfer [Girdlestone-Taylor procedure]. This procedure involves a release of one of the tendons that pulls the toe downwards (the flexor digitorum longus) at the tip of the toe (distally) and a transfer of this tendon to the top of the toe (dorsal aspect of the proximal phalanx). This procedure aims to convert one of the primary deforming forces leading to clawing of the toes into a force that helps correct the deformity. It produces a fairly predictable correction of the toes, however, the surgery is slightly more involved than some of the other procedures.
- wound healing problems
- nonunion (if the PIP joint is fused)
- local nerve injury to the nerves that provide sensation to the tips of the toes
- Malunion: It is common for the toe to heal in a position that may not be perfectly straight. Minor degrees of deformity will be mostly a cosmetic concern, which is why almost all surgeons discourage patients from having toe surgery if the concerns are mostly cosmetic.
- Recurrence of the Deformity: Other complications include failure to fully correct the claw toe deformity or the potential for recurrence of the deformity over time.
- Loss of blood supply to the tip of the toe. The blood supply to the tip of the toe can be tenuous. There are two small arteries (one on either side of the toe) which supply blood to the tip of the toe. If the blood supply to the tip of the toe is lost the tissue will die and it may be necessary to amputate part, or all of the toe.
However, these risks do not ocur often and most patients are happy with the results from this surgery.