Claw Toe

Your forefoot is made up of 4 phalanges (smaller toes) and 1 hallux (big toe). Your phalanges have 3 bones as well as 3 joints (MTP joint - nearest base of foot, PIP joint ­ middle, and DIP joint - tip of toe); your big toe only has 2 bones and joints. Your midfoot (metatarsal bones) and hindfoot (tarsal bones) make up your foot arches, instep, heel and ankle; these are responsible for weight bearing and propulsion. Your arches contain bones, ligaments, muscles and tendons of your foot, which require a lot of stability and flexibility.

Claw toe makes your toes bend and look like a claw. It causes your MTP joint to bend up, your PIP joint to bend down and your DIP joint to curl under. This often affects all your small toes at one time; however it can affect just one. It can be flexible (joint has ability to move) or rigid (joint has limited and/or no ability to move). Failure to treat it can breakdown tissues which affect the way you walk and lead to serious toe, foot, knee, or hip ailments, and/or infection. A claw toe deformity is most seen in people over 65 years of age, the chance of suffering from claw toe increases by 2 - 20% with age. Both men and women are at risk; however women are 5 times more likely to experience it than men.

Causes

If you have claw toe your flexor digitorum brevis muscle (on bottom of toes) is often stronger than your deeper toe muscles; which creates a high foot arch and a muscle imbalance (weaker toe muscles are overpowered).

Inappropriate footwear (short, tight, narrow, pointed, or high heels) puts pressure on your feet and keeps your toes in an unnatural, bent position. Wearing this type of shoe for long periods of time prevents your muscles from straightening your toe even when not wearing shoes. Often corns or calluses (hard growths of dead skin) or bunions (enlargement of bone or tissue on big toe) will develop around these pressure points from rubbing against shoes, which initiates claw toe.

Other mallet toe causes:
Muscle, nerve and joint damage from neuromuscular diseases (stroke, multiple sclerosis, Charcot-Marie Tooth disease, cerebral palsy, degenerative disc disease), diabetes, alcoholism, poor blood flow to your feet (peripheral arterial disease), inflammatory diseases (rheumatoid arthritis, psoriasis) or osteoarthritis
Conditions from birth, hereditary characteristics or abnormal toe bone lengths
Previous toe injuries, dislocation of toe joints or poor foot mechanics
Excessive weight and activity levels

Symptoms

You will often have constant pain in your toe when moving it as a result of corns, calluses, bunions or blisters; generally found on the top, tip or base of your toes. The discomfort from your high arch causes your toes to cramp and your foot to shorten. This pain can radiate to your entire foot and lower leg, and can lead to posture and balance changes (affecting the way you walk). It will be difficult for you to find shoes that fit properly.

Other hammer toe symptoms:

• Inflammation, redness and swelling in toe joints, synovial membrane (connective tissue and fluid which lines joint cavity), and bursa (fluid filled sac between tendons, ligaments and bones preventing friction)
• Deformed nails
• Infections or ulcers in toes
• Pigment discoloration

Diagnosing Claw Toe

Your doctor will take your medical history and will examine your foot and toe for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray (check for arthritis or bone and joint inflammation) or blood and nerve tests (rule out diseases or infections) may be requested.

Treatment and Prevention

Early diagnosis and proper treatment are important, however clawtoe can be difficult to prevent as symptoms often start long after you¹ve had the condition. The goal is to relieve pain, reduce friction and transfer pressure from your sensitive areas. If your clawtoe is flexible, you can often manually straighten your toe. If your clawtoe is rigid, extra stress at the ball of your foot prevents your toe from straightening; you may require more extensive treatment. Failure to see improvements after conservative treatments may make surgery your only option.

Ultrasound is an excellent tool to reduce pain and inflammation when treating claw toe. The application of ultrasound over the affected toe and foot area reduces swelling, increases blood flow, decreases pain, relieves tension making muscles and tendons more flexible, minimizes scar tissue, and helps tissues heal more quickly. It can be performed at home easily and safely with a portable ultrasound device.

Other conservative treatments:

1. Properly sized, adjustable, low-heeled footwear provide room and comfort (leave a 1/2 inch space between longest toe and inside of shoe); avoid super-snug stockings, nylons and socks


2. Footwear made out of breathable and flexible materials help prevent against corns, calluses and bunions (avoid vinyl or plastic materials)


3. Corrective footwear, orthotics or other foot devices provide support and alignment (check to see if you wear out the soles of your shoes on one side)



4. Cushioning or supportive items, such as splints, taping, straps, non-medicated felt pads, moleskin, toe shields or caps, protect and reposition your toe, and relieve pressure pain


5. A healthy diet especially if you have diabetes (more prone to poor circulation and lack of feeling in your feet) keeps your body healthy


6. Exercises that stretch and strengthen your foot muscles and tendons keep your muscles balanced


7. Gentle foot massage after vigorous activities or long periods of standing help relax tissues; physical therapy, foot manipulation and reflexology are good for severe cases


8. Exercises that stretch and strengthen your foot muscles and tendons keep your muscles balanced


9. Soak your toes in alternating warm and cold water baths; gently rub your corns or calluses with a pumice stone or nail file while your feet are in warm water

Toe surgery (tenotomy, tendon transfer, arthroplasty, or arthrodesis) helps to straighten your toe joint in severe cases when the soft tissues in your toes become very stiff and don't move at all. However, surgery is not always effective; it may improve the look of your foot, however there's no guarantee the problem won't come back after surgery. Botox has also been used for claw toe.

Recovery from claw toe can take between 4 weeks - 6 months, depending on the severity of your condition and your commitment to proper rehabilitation. The more dedicated you are with your treatments, the faster you will see successful, long-lasting results.

See Toe Deformities for more detailed information.