Claw Toe

The toes, part of the forefoot, play a key role in maintaining balance and facilitating movement. The big toe, known as the hallux, has two bones (phalanges), while the second to fifth toes contain three bones each. In claw toe, the joint at the base of the toe bends upward while the other joints bend downward, giving the toe a claw-like appearance.

Claw toe can be congenital or develop later due to various factors that affect the nerves, muscles, or tendons of the toes. Conditions like alcoholism, diabetes, multiple sclerosis, stroke, Charcot-Marie-Tooth disease, rheumatoid arthritis, spinal cord disorders, and cerebral palsy increase the risk. Ill-fitting shoes, especially high heels or pointed-toe footwear, can also contribute. The condition is four to five times more common in women, particularly in their 70s and 80s. In some cases, the cause of claw toe remains unknown.

Claw toe causes upward bending at the toe’s base and downward bending at other joints, sometimes curling the toe under the foot. This can cause discomfort, especially at the toe’s base or tip, and may result in malformed toenails, corns on top of the toes, and calluses on the ball of the foot. Finding comfortable shoes can be challenging, and without treatment, the condition worsens, leading to permanent deformity and difficulty walking.

A doctor can diagnose claw toe through a physical examination and a review of the patient’s medical history. X-rays are usually taken, and in some cases, nerve studies may be performed to further assess the condition.

Treatment varies based on the underlying cause and whether the toe joints are still flexible. Addressing the root medical condition is essential but may not reverse the claw toe. For flexible joints, doctors may recommend specialized footwear, cushions, and pads to relieve pressure and properly align the toes. Patients are advised to avoid high heels and narrow shoes. Corns and calluses can be safely removed by a doctor, and self-removal should be avoided.

If the toe joints become rigid or fixed, surgery might be required to realign them. Claw toe surgery is typically an outpatient procedure and may involve lengthening or transferring tendons, removing cartilage from the bones, or using surgical hardware to hold the bones in place. Recovery may require the temporary use of crutches or a walker.

Post-surgery recovery for claw toe can take several weeks. Daily dressing changes are needed, and stitches are usually removed after about two weeks. Surgical pins are typically removed two to four weeks following the procedure.