Claw toe, as the name implies, is the bending of the toe into a claw-like shape. It most commonly affects the second toe, but can also affect the third to fifth toes.
- 735.5 Claw toe (acquired)
- 755.66 Other anomalies of toes
- M20.5X9 Other deformities of toes (acquired), unspecified foot
Today, in this article, we will discuss claw toe causes, features, signs, symptoms, and treatment of this deformity.
Anatomy of the toes:
Key Features of Claw Toe:
-Toes are bent into a claw-like position.
-Shortening of flexor digitorum Brevis.
-Hyperextension (dorsiflexion) of the MTP joint with flexion (plantar flexion) of the PIP, DIP is plantar flex.
-Shortening of flexor muscles, fascia, and tendons.
Signs & Symptoms:
- Pain in the metatarsal with walking.
- Corn is present on the top of the toe.
- Alteration in the position of the joint.
- Decrease in the dorsiflexion of the toes.
- There is redness and pain in the affected joint.
- Callus formation under the head of the metatarsal.
- Limited motion of the metatarsal phalangeal joint.
NOTE: Corns are small and round whereas callus is larger and has a more irregular shape. These are formed by rubbing the toes inside the shoe. They may be painful or not.
The most common cause of the claw toe is muscle imbalance. Foot muscles can become imbalanced due to the following reasons:
- Tibia fracture
- Pes planus
- Improper footwear
- Commonly seen in conjunction with bunions
- Joint injury
- Muscle atrophy
- Nerve damage
- Spinal cord injury
- Friedreich ataxia
- Osteoarthritis or Rheumatoid arthritis
- Charcot-Marie-Tooth disease
- Diabetes mellitus
There are two stages of claw toe:
- FLEXIBLE (Early stage): At this stage, the toes will still flex at the joints, although they’re stiff.
- RIGID (Late stage): At this stage, the toes will become stiff and will not move.
- Mallet toe: neutral MTP and PIP joint with flexion of the only DIP.
- Hammer toe: neutral or dorsiflexed MTP, plantar flexed PIP, and neutral or flexed DIP.
- Hallux rigidus
- Osteochondritis dissecans
- Metatarsal stress fracture
- Sesamoiditis, turf toe
It consists of AP, lateral and oblique X-ray views. Findings are bone spur, location, and size which help to assess the extent of the disease and help to plan the treatment.
Tests and Measures:
- ROM of PIP & DIP
- Lower limb strength
- Balance test by static single-leg standing while eyes open and closed
- Gait observation and assessment by 2-minute and 6-minute walk test
Treatment of Claw Toe:
Claw toe can be treated surgically as well as non-surgically.
- To straighten out the toe:
- Cut or lengthen tendons and ligaments
- Fusion of the joint
- Tendon transfer
- Rest, to reduce inflammation by weight off feet
- Orthotics with ray cut out
- If swelling is present, cryotherapy should be done
- In case of pain,
- Electrical stimulation
- Joint mobilization,
- MTP medial, lateral, anterior, posterior glides, and rotation.
- Posterior talus glide
- Subtalar joint inversion and eversion.
-In case of weakness, strengthening exercises will be done:
- CALF RAISES
2. TOWEL CURLS:
3. STANDING ARCH RAISES:
4. ACTIVE WALKING:
-If there is a lack of flexibility, then stretching should be done:
- TOE STRETCHING:
NOTE: Stretching of the thumb, as shown above, is done and stretching of all other toes should be done the same way.
2. CALF STRETCH:
-Patient education in footwear: shoe with a rocker’s bottom to limit first ray extension.
Prevention of Claw Toe:
The occurrence of claw toes can be prevented in the following ways:
- BY EXERCISING YOUR TOES: Stretching and strengthening of your toe muscles should be done to prevent the risk of claw toes.
- BY PROPER FOOTWEAR: Proper footwear is very important to prevent this deformity. Shoes with wide toe boxes and rocker’s bottom are recommended to overcome this condition.
- BY USING PUMICE STONE: The use of pumice stone over the corns and callus can soften them and can reduce pain from friction.