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What is Claw Toe?

A claw toe, hammer toe, or mallet toe is a toe that is bent at both the middle and end joints in the toe, known anatomically as the DIP and PIP joints, and a dorsiflexion (a muscle that causes backward flexion) deformity at the metatarsal phalangeal joint. This condition can lead to severe pressure and pain. It is similar anatomically to bunions because both are a result of weak muscles that cause a deformity to the bone. Hammertoes occur in the four smaller toes, and because they all tend to be affected, the condition is sometimes known as 'claw foot.' The joints of the toes buckle abnormally, and have a curved, or claw-like appearance.

Causes of Claw Toe

Claw toe is usually caused by weak foot muscles, as a byproduct of a neurological condition affecting the strength of these muscles.

These conditions include:

  • Diabetes
  • Rheumatoid or osteoarthritis
  • Alcoholism
  • Charcot-Marie-Tooth disease
  • Spinal cord tumors
  • Polio
  • Stroke

The cause of the condition is a tightening of the ligaments and tendons of the toe, causing a buckling of one or more joints of the toe. The result is a cocking of the toe upward, whereas in a normal foot, the toes lie flat. Shoes can then rub on the top of the cocked toe, eventually causing painful corns or calluses. If the deformities are not treated, the toe may become permanently fixed and rigid. In this condition, all of the toes tend to be affected, not just one or two.

Symptoms of Claw Toe

The main symptom is toe pain. There will also be an obvious claw-shaped deformity to the affected toes, in addition to pain and calluses caused by the upper part of the toes rubbing against the shoe. Corns or calluses may also develop on the tip of the toes from pressure and rubbing on the bottom of the shoe. Patients may find it difficult finding shoes that do not cause pain, and infections may develop as a result. Ulcers may develop in patients with diabetes because of decreased sensitivity in the foot.

Treatment of Claw Toe

All three conditions can be treated with conservative measures, if treatment is begun early and the abnormal position is not rigidly fixed.

These include:

  • Wearing shoes with soft and roomy toe boxes (at least ½ inch longer than the longest toe)
  • Strengthening toe muscles with exercises such as picking up marbles with the toes and stretching exercises
  • Stretching the upper part of the shoe to help accommodate toe pain
  • Wearing soft pads in the shoe over the corns or calluses

If the hammer toe condition is rigid (inflexible, fixed), surgery may be required, with a goal of realigning the toe.

Procedures may include:

  • Cutting, lengthening, or repositioning tendons, or shortening the bone of the phalanx.
  • Insertion of a steel pin to fix the corrected position of the toe.

Living with Claw Toe

Any change to one part of the foot significantly affects habitual ways of walking and standing. Left untreated, foot ailments such as claw toe, hammer toe, or mallet toe may produce problems in other weight-bearing joints, such as the hips or knees.

Any forefoot problems causing pain or discomfort should be given prompt attention. People who experience problems with their feet should seek advice from an experienced physician or podiatrist who can evaluate the risks, benefits, and possible complications of various treatment options. Patient compliance is particularly important in the treatment of these conditions.

Ignoring the symptoms of deformities of the toes can aggravate these conditions and lead to a breakdown of tissue, or even infection. Conservative treatment starts with accommodating the deformity. The goal is to relieve pressure, reduce friction, and transfer force from the sensitive areas. If surgery is recommended, it is important to fully understand and follow the recommendations of the surgeon before and after the procedure.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

©2000, LLC, Indianapolis, IN

What are Deformities of the Toes?

The foot is a highly mechanical apparatus, made of many bones and other coordinated structures. The foot carries the entire weight of the body and propels us forward when we stand, walk, and run. Several common deformities of the toes—claw toe, hammer toe, and mallet toe —often cause pain and a loss of function in the use of the foot. Failure to treat these conditions may contribute to the development of serious and disabling changes in habitual ways of walking and carrying the body.

Claw toe, mallet toe, and hammer toe are all deformities of the toes. While they are somewhat similar in appearance, each has specific characteristics. Variations in the three conditions are caused by differences in the direction the joints of the affected toes bend, as well as in degrees of deformity.

Toe deformities are often congenital, occurring for example, in some people with muscular dystrophy. People with high arches, or those who have a tendency to rotate their feet inward while walking are susceptible to deformities of the toes, as are those with rheumatoid or osteoarthritis and people with diabetes. Proper evaluation is the first step in understanding toe deformities and the problems they present. Seeking early evaluation for disorders of the toes and feet is always a good choice, and can make a significant difference in controlling the condition.

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