CLAW TOE

Claw toe most frequently develops in older women. It causes the joint at the base of the toe to bend upward and the other joints on the toe to bend downward in the shape of a claw. Claw toe may be related to underlying medical conditions or caused from wearing poor fitting shoes. It is important to diagnose and treat claw toe early because the condition tends to become worse over time. Significant cases of claw toe may require surgery to correct the toe joints.

Anatomy

Your toes are part of your forefoot. They help you balance, walk, and move. Your big toe (hallux) contains two bones (phalanges). Your second through fifth toes contain three bones. Claw toe results when the joint at the base of the toe is bent (contracted) upward and the remaining joints in the toe bend downward, creating the appearance of a curved claw.

Causes

People may be born with claw toe or develop the condition later in life for a variety of reasons that are associated with structural changes in the nerves, muscles, or tendons that bend the toes. Alcoholism, diabetes, multiple sclerosis, stroke, Charcot-Marie-Tooth disease, rheumatoid arthritis, spinal cord disorders, and cerebral palsy increase the risk of developing claw toe. It can be an inherited condition for some people. Wearing shoes that are too small or have high heels and pointed toes can contribute to claw toe. In some cases, the cause of claw toe is unknown.

Claw toe is four to five times more common in women than in men. The likelihood of claw toe increases with age. It most frequently develops in adults that are in their 70s or 80s.

Symptoms

Claw toe causes the joint at the base of the toe to bend upward and the remaining joints on the toe to bend downward, even to the point of curling under the foot. The affected toe may be painful or irritated, especially at the base or tip of the toe. Your toenail may be malformed. Areas of thickened skin (corns) may develop on top of the toe and thickened skin (calluses) may appear on the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear. Without treatment, claw toe tends to get worse over time, leads to a permanently deformed toe, and interferes with walking.

Diagnosis

Your doctor can diagnose claw toe by reviewing your medical history and examining your foot. X-rays will be taken. In some cases, nerve studies may be conducted.

Treatment

Treatments for claw toe depends on its cause and if the toe joints are flexible or rigid. Although treating the underlying medical conditions is important to overall health, it usually does not reverse claw toe. If your toe joints are still flexible, your doctor may recommend specific shoes, cushions, linings, and pads to help absorb force and place your toes in the proper position. You should avoid wearing high heel narrow toed shoes.

Your doctor can safely remove corns and calluses. You should not try to remove them at home.

Surgery

Surgery may be necessary to correct the angle of rigid or fixed toe joints. Surgery for claw toe is usually an outpatient procedure. Surgery can entail lengthening or transferring tendons, removing cartilage at the end of bones, and using surgical hardware to hold the bones in position. You may need to use crutches or a walker for a short time following surgery.

Recovery

Recovery from claw toe surgery can take several weeks. Fresh dressings are applied daily. After about 2 weeks stitches are removed. Surgical pins are removed after about two to four weeks.

Prevention

You may help prevent claw toe by taking care of underlying medical conditions that can be treated. Wearing low healed shoes with a roomy toe box can help. Be sure to follow your doctor’s recommendations for using pads or special insoles.