A claw toe is a type of deformity of the toe which involves:
- the toe being bent downwards (flexion) at the middle joint of the toe (PIP Joint)
- the toe being bent upwards (extension) at the joint at the ball of the foot (MTP Joint)
- sometimes the toe can also be bent downwards at the end joint (DIPJ), resulting in the toe curling under.
Because of the deformity, painful corns or calluses often form over the top of the toe or under the ball of the foot.
Claw toe can be inherited and present from birth, however it is commonly caused by wearing poorly fitting shoes, including shoes that are too short or heels that are too high. Under these conditions, your toe may be forced against the front of your shoe, resulting in an unnatural bending of your toe and a claw-like appearance.
A simple measure of relieving the pain and pressure of claw toe is changing your footwear. However, in more severe cases of claw toe, surgery may be needed.
Symptoms
- Deformity in the toe – this may be either flexible or stiff (rigid)
- Pain – the claw toe itself is often painful, but there may also be pain in other joints as the toe affects normal walking patterns
- Formation of hard calluses (‘hyperkeratosis’), occasionally ulcers may develop
Causes
Claw Toe occurs when the forces acting around the joint are not balanced. There are many reasons that this can occur, including shoes putting pressure across the joint or other deformities in the foot.
- Inherited
- Acquired claw toe:
- Poor footwear
- Other deformities in the foot or ankle can disturb the balance of forces around the toe
- Arthritis and nerve dysfunction (for example, Charcot-Marie-Tooth disease or Diabetes)
Risk Factors
- Other deformities in the foot or ankle, including pes planus (flatfoot), pes cavus, metatarsus adductus
- Long toes
- Family history of toe, foot and/or ankle deformities
- Arthritis
Investigations
Your GP may be able to diagnose claw toe simply by looking at and feeling your foot. The diagnosis is usually confirmed with X-rays, and occasionally CT scans.
Other tests that may also be used include blood tests and nerve studies. These tests are only necessary when your doctor suspects an underlying cause for the deformity, for example arthritis.
Complications
Untreated claw toe may progress to more severe deformity, and from flexible to stiff deformity. As the deformity worsens, the risk of developing other complications, like ulcers, calluses, arthritis in other joints and an abnormal gait increases. The deformity may also lead to disease in the nail, including ingrown and broken nails. All of these factors can lead to worsening pain and difficulty walking.
Occasionally, ulcers that form around the deformed toe can become infected. The infection can spread into the soft tissues deep to the skin, and even spread into the bone causing osteomyelitis. This is a rare serious complication that is more common in diabetics.
Treatment
Normally, claw toe is treated without surgery. Your doctor can suggest
- Different footwear – this will sometimes involve referral to an orthotist. Generally, wide padded shoes help to relieve the symptoms and potentially correct the deformity.
- Pain medication. This can be simple over-the-counter pain relief, however occasionally injections of steroids into the joint can also relieve inflammation and pain.
If the deformity is due to an underlying condition like arthritis this will require its own treatment. Deformities associated with diabetes will often require referral to a podiatrist.
Surgery for claw toe is indicated when
- The deformity is causing significant symptoms that are not relieved by non-surgical measures. ‘Significant symptoms’ can be defined in many ways, but generally substantial impact on life and work are the key considerations.
- Surgery is only recommended when you are considered ‘fit’ for surgery – that is, surgery is safe. Generally, surgery becomes more dangerous in the elderly, and in those with significant heart and/or lung disease. Surgery will always be preceded with pre-operative testing to confirm that the patient is fit for surgery.
The operation to correct claw toe is generally fairly minor and able to be performed without keeping the patient overnight. This varies depending on individual cases and should always be discussed with your surgeon.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Wearing well-fitting and comfortable shoes is very important to protect your feet from developing deformities. It is also important to take care of your feet and see your GP or other health care provider as soon as you notice any deformities.
F.A.Q. | Frequently Asked Questions
What is the difference between a claw toe, a hammer toe and a mallet toe?
They are named for where the toe bends. A claw toe bends up at the joint where the toe meets the foot, and down at both joints beyond it. A hammer toe bends down at the middle joint. A mallet toe bends down at the joint nearest the nail.
Will it straighten on its own?
No. Claw toes do not correct themselves and usually get slowly worse. Early on the toe can still be straightened by hand. Later the joint stiffens and stays bent.
Why does it matter if it goes stiff?
While the toe is still bendy, roomier shoes and padding can take the pressure off and keep you comfortable. Once the toe is stiff, only surgery will straighten it.
Do I need an operation?
Most people do not. Surgery is for a toe that stays painful in spite of good shoes and padding, or where a sore keeps coming back on the toe.
What shoes should I wear?
Shoes with a deep, wide, rounded toe box and a low heel. There should be room above your toes so they are not pressed against the top of the shoe. See footwear in orthopaedics.
Can I cut the corn off myself?
It is safer to have corns trimmed by a podiatrist. Corn removers you buy over the counter contain acid and can damage healthy skin. This matters most if you have diabetes or poor circulation.
Why have I got claw toes?
Often there is no single reason. Tight shoes, a long second toe, and a high arch all play a part. Sometimes claw toes are a sign of a nerve or muscle problem, so your doctor may check for that.
References
Barakat, M. J., et al., ‘Curly toe, hammer toe, claw toe and mallet toe: are they good descriptive terms of the associated deformities of the lesser toes?’, European Journal of Orthopaedic Surgery & Traumatology, Vol. 15, 2005, pp 226–228.
Mann J. A., et al., “Chapter 9. Foot & Ankle Surgery”, Skinner HB: CURRENT Diagnosis & Treatment in Orthopedics, 4e: http://www.accessmedicine.com/content.aspx?aID=2321540.
Schuberth, J. M., ‘Hammer Toe Syndrome’, The Journal of Foot and Ankle Surgery, Vol. 38, No. 2, March/April 1999, pp. 166–178.