Claw toe is a condition in which the toes curl into a claw-like position. Though some people are born with claw toe, most people develop it later in life. Typically, the condition isn’t serious, though it can be uncomfortable and eventually lead to painful complications. In some people, claw toe is a sign of an underlying condition such as diabetes. Shoe type, foot structure, and trauma can each contribute to the formation of claw toe.

Anatomy of Claw Toe

Though it may seem as though the majority of the foot is solid bone, the skeletal structure of the feet actually resembles the skeletal structure of the hands. The toes consist of the distal, middle, and proximal phalanges and connect to the metatarsal bones that make up the majority of the foot. Claw toe occurs when a proximal phalanx performs dorsiflexion at the metatarsophalangeal joint while performing flexion on the proximal interphalangeal and distal interphalangeal joints. This means that the toe joints closest to the ankle curve upward while the other toe joints bend downward.

Other Symptoms

Beyond the curling of the toes, several other symptoms may develop as a result of claw toe. Because the toes are constantly rubbing against shoes, claw toe can cause the growth of corns or calluses. Some people with diabetes experience decreased foot sensitivity, which can then lead to the development of ulcers. Rarely, there may be an infection of the toes, corns, or calluses. In some cases, a person with claw toes may also develop a bunion on their big toe. Though some cases of claw toe are asymptomatic, many people with the condition experience mild to moderate discomfort or pain.

Causes

There are a variety of possible causes for claw toe, one of the most prominent being improperly fitting footwear. Certain ankle surgeries or injuries may lead to claw toe or similar issues. Inflammation and swelling of the foot may cause the toes to bend for extended periods. Without treatment, this can eventually become claw toe as well. Physicians have also found that claw toe is a possible symptom of many other disorders and conditions. Typically, these conditions cause nerve damage that weakens the foot muscles or directly affects muscle tone.

Underlying Conditions

The three most prominent underlying conditions that cause claw toe are rheumatoid arthritis, cerebral palsy, and diabetes. Rheumatoid arthritis is an autoimmune disorder that causes the body’s immune system to begin attacking its own joints. This can result in joint damage and deformities that may eventually manifest as conditions such as claw toe. Cerebral palsy is a group of disorders that directly affect muscle movement and coordination, as well as vision and hearing. Muscle weakness is common in individuals with cerebral palsy and is a prominent cause of claw toe. Diabetes occurs when the body possesses abnormally high insulin resistance or is incapable of producing an adequate amount of insulin. This causes the body’s blood sugar levels to remain excessively high. Nerve damage is a common complication of diabetes.

Risk Factors

In addition to the many direct causes, several risk factors may signal a higher chance of developing conditions such as claw toe.

• Generally, the risk of claw toe increases with age.
• Women are significantly more likely to develop claw toe than men, though this may be due to the widespread popularity of footwear such as high heels.
• Individuals with long toes have a higher risk of claw toe, particularly if one or multiple toes are significantly longer than the others.

Claw Toe and Similar Conditions

Several conditions are incredibly similar to claw toe. These are mallet toe, hammer toe, and the lesser known curly toe. Typically, physicians differentiate between these conditions by determining which toe joints are bending and the method in which they bend. For example, in hammer toe, usually only the middle joints of the toe bend. Whereas with mallet toe, only the end joints of the toes bend. Curly toe is unique in that it requires a specific degree of movement. Plantar flexion describes a movement in which the top of the foot points away from the leg. Curly toe requires plantar flexion of the middle and end joints that is greater than five degrees.

Prevention

People can take various steps to avoid the development of claw toe. Primarily, many people develop the condition due to poorly fitting footwear. Wearing shoes that have adequate toe room and low heels can give the toes room to properly extend. Shoes with adjustable laces or straps are also ideal. To ensure that shoes will fit correctly, it can be beneficial to purchase them towards the end of the day. Most people’s feet swell throughout the day and will be at their largest during later hours.

Conservative Treatment

Physicians will generally opt for conservative treatment if there is still some mobility in the affected toes. This may begin with roomier and more comfortable footwear. Some doctors may insist on orthotics such as shoe inserts or insoles. These can help reposition the feet and toes to alleviate pain and improve posture. Physical therapists may recommend foot exercises such as picking up marbles or crumpling towels with the toes to properly strengthen the muscles of the feet.

Surgery

If conservative treatment methods do not appear to help, or the condition is already severe, doctors may choose to use surgical methods instead. Often, the surgery focuses on releasing the tendon or tendons that are causing the claw toe. Releasing the tendon enables the toe to lie flat. For some patients, it may be necessary for surgeons to remove sections of bone to properly straighten the toes. Physical therapy may occur in the weeks following the surgery to ensure proper recovery and muscle development.

Prognosis

For most people, proper treatment is necessary to prevent pain and other complications. Additionally, the condition may recur in older individuals, even with surgical intervention. Younger people tend to recover more fully, though minor pain is still common. Many people find greater success through constant and consistent toe and foot exercises. Those who receive surgery may experience a notable loss of prehensile action in their toes, but also significant pain relief.