Claw Toes - Causes and Corrections

Claw toe is a result of the flexor digitorum brevis (attached to the middle bone, also called the middle phalanx) contracting and eventually overpowering all of the toe muscles. This contraction pulls the middle downward. Consequently, the joint flanked by the middle phalanges and the proximal clasp upward.

Claw toes need to be treated early or they may become serious claw toe deformity. A foot claw toe causes the foot to rub against the inside of the shoes, leading to calluses. Worse, because the metatarsal heads are forced to support the weight, open sores (also called foot ulcer) may develop on the soles of the feet. The earlier claw toes are treated, the easier they can be straightened.

Claw Toe Signs and Symptoms

The toes of people with foot claw toe bend upward from the foot’s ball joints, and sometimes downward to the sole at the middle joints. The downward bend may also happen at the top joints. Corns usually also appear either under the ball or on the top of the toe.

Claw Toes Causes and Risk Factors

Claw toe deformity is usually caused by muscle imbalances in the foot. People with flat feet (a condition also called pes planus), people who have suffered traumatic foot injuries, and people with underlying diseases are more prone to claw toes.

Patients who have inflammatory illnesses such as diabetes, rheumatoid arthritis or psoriasis are at risk, and so are those with neuromuscular illnesses such as cerebral palsy, Charcot-Marie-Tooth disease, and multiple sclerosis.

Tests and Diagnosis of Foot Claw Toe

Because a claw toe is very evident, a physical examination is sometimes all the physician needs to diagnose it. Most doctors also measure the foot’s stability and flexibility, and look for signs of abnormal sensation in the toe during the examination.

Doctors also check for swelling, erythema (or abnormal redness), and calluses. In some cases, doctors require patients to undergo foot X-rays to accurately determine toe position and also to spot any bone inflammations, arthritis, or joint lining inflammation. In order to rule out diseases such as diabetes and other infections, blood tests may be required.

Claw Toe Correction and Treatments

When detected early, claw toes can be straightened without surgery. Some podiatrists make custom orthotics for patients whose claw toe deformity is caused by flat footedness, for example.

When claw toe is not deteced early enough and the soft tissues that fasten to claw have tightened, surgery becomes necessary. There are two types of claw toe surgery:

Arthroplasty.

This type of surgery is ‘minor’ in that a simple incision is made along the toe. The proximal phalanx head is then trimmed, letting the toe straighten. Progressive surgeries may be necessary until the degree of straightening required is achieved, If unsuccessful, the patient may be advised to undergo arthrodesis.

Arthrodesis.

This type of surgery is for more serious cases of claw foot. The middle phalanges and proximal bone are fused together. The cartilage is removed from the middle phalanx base, and then the two bones are fixed together using a pin (usually removable) until they fuse together.

Patients who undergo arthrodesis cannot use their feet for a number of weeks. Like any type of surgery, arthrodesis has its complications. Some patients suffer from infection after surgery. Some also suffer from toe numbness.

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