Orthopedics-Online

Claw toes

Synonyms

Claw toe, claw toe

introduction

Clawed toes are toe misalignments that often occur together with hallux valgus and splayfoot. They are characterized by an overstretching of the base joint with the middle and toe-end joints bent. There are many causes for claw toes to develop. Basically, a differentiation is made between congenital causes, such as foot misalignments in the sense of splayfoot, flat foot and buckled foot, and neurological and accident-related foot diseases. In addition, civil-historical influences, such as too tight shoes and not walking barefoot, play a decisive role.

In the course of life there is a gradual toe curvature and painful pressure points all over the foot with the formation of corns (clavus). Consistent conservative measures such as toe gymnastics, padding, insoles and wearing wide open shoes cannot always stop the worsening even in the early stages of the disease, so that in the further course an operation may be necessary. Nevertheless, you should also start doing foot gymnastics independently at an early stage.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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frequency

Claw toes are common toe malformations. They usually occur in combination with other foot deformities such as hallux valgus or splayfoot. In the early stages, the toes can often still be passively returned to their normal position; in the further course of the process, the joint parts of the toes II - V are stiffened neither passively nor actively.

Overall, claw toes are less common than hammer toes.

Also read: Hammer toe

causes

In addition to a genetically inherited component, the cause of toe deformities is, among other things, wearing unsuitable shoes, often with too high heels. In shoes that are too tight, the toes bump into the front and bend, the pressure on the so-called forefoot increases. The short toe extensors in particular have the function of keeping the toes in their extended position. However, due to a lack of exercise and constant support of the foot muscles through the footwear, the foot muscles atrophy. As the disease progresses, the flexor muscles become more pulled, which increases the curvature of the toes. These also shorten over time and additionally bend the toes.
Some other reasons for a claw toe to develop include the following reasons:

neurological disorders, especially in the archesus and in spastic paralysis
from muscle and nerve damage to the lower leg and foot
inflammatory diseases of the foot, rheumatoid arthritis
Scarring, through hardening of the scar tissue
Sudeck's dystrophy (tissue changes after an accident)
in rare cases, claw toes can be congenital

Symptoms of claw toes

If claw toes are present, the metatarsophalangeal joints are hyperextended. while the toe and toe joints are flexed. There may be purely cosmetic problems with the toes. In the claw toe, some very pronounced malpositions are very low in pain, while minor malpositions are very painful, which can significantly reduce the quality of life. One cannot draw a conclusion from the degree of the deformity and the complaints. Overall, the toe deformity of the claw toe slowly but steadily increases.

Due to the misalignment of the toes, there is an incorrect static load on the foot. This incorrect load often leads to pressure points that can become inflamed.

With the claw toe, the toes become shorter due to the incorrect load, but they take up more space in the arch of the foot. As a result, the central toe joint in particular touches the shoe cover. If a chronic pressure point develops, the skin becomes thickened and a corn (clavus) develops.

If the misalignment of the feet persists for a long time, the toes stiffen in the misalignment, and in their appearance they look downright crippled. The misalignment can lead to different toes lying on top of each other. In individual cases, the toes slip completely out of the base joint (luxate), which means that the toes cannot function properly.

Pain

Pain in claw toes mainly occurs when there are pressure points on the toe joints. Due to the claw-like misalignment, pressure is constantly exerted on the protruding bone parts when wearing closed shoes. This leads to cornification. With these so-called corns, an inward-reaching cone of horns (keratoconus) often forms, which can trigger very severe pain due to irritation of the periosteum. Therefore, it is best to prevent or treat such complaints by taking action against the causal claw toes. Depending on the extent, various non-surgical options are possible. Often, however, these are not enough and only an operation on the claw toes can relieve the pain in the long term. Painful corns should also be counteracted by regular foot care and not too tight shoes.

Corns

Corn or clavus is the name given to painful callosities, which are caused by constant pressure on skin near the bone and often occur due to clawed toes in the area of the toe joints. Due to the misalignment of the toes, pressure is constantly exerted on these areas when wearing shoes, so that corns often form. In addition to appropriate treatment of the causative claw toes, corns can be treated with various measures or their development can be prevented. It is important to take care of these yourself regularly or to have them cared for as part of a pedicure. It is important to carefully remove excessive callus, keep the nails in shape and regularly apply cream to the feet if the skin is dry. In the case of acute painful pressure points, the temporary application of a protective bandage to relieve the pressure can be useful.

You might be interested in: Treatment of corns

Treatment of claw toes

In the treatment of claw toes, a distinction is made between conservative therapy and surgical therapy.

Conservative therapy of claw toes

In principle, both conservative and surgical therapeutic measures are available for the claw toes. Conservative therapy of the claw toes is recommended for toe deformities that can still be passively compensated. First of all, an attempt should always be made with conservative treatment measures. However, conservative therapy for the claw toes is often unsatisfactory. If the cause of the toe misalignment is not rigorously eliminated, the deformity and callus formation will progress slowly but steadily.

Conservative treatment measures are:

Influencing the causal deformity e.g. through splayfoot insert, night splints and reins
Toe exercises
Relief measures for the pressure points, with comfortable shoes with soft leather, sandals, padding measures (felt rings / rubber pads)
Pedicure, whereby the calluses and corns return regularly without eliminating the cause.

Further information on this topic can be found at: Therapy of claw toes

Claw toe surgery

If conservative treatment methods have failed to produce an adequate result, surgical treatment of the disease should be considered. There are different surgical treatment options that can achieve lasting improvement in symptoms. As a rule, attempts are made to shorten the bony structures of the foot and stretch the shortened tendon. These measures put the toes back into their original position. The results of the operations are usually very good and full exposure is possible within a few days after the operation.

Various surgical measures for claw toes are:

Tendon displacement: If the deformity is mild, it may be sufficient to move the shortened tendon on the sole side to the back of the toe. This eliminates the flexion in the middle and end joints.
Operation according to Hohmann: Here, the misaligned joint is partially removed and the corrected toe is then stiffened in the new position using connective tissue. This orthopedic surgical procedure is called osteotomy. Approximately one third of the metatarsophalangeal joint is removed, which enables the toe to be repositioned. Possibly. the shortened flexor tendon must also be lengthened. Then the toe is fixed in the new, corrected position with a wire that is inserted into the toe from the front and extends into the metatarsus.

For further information on this topic, we recommend our website: Claw toe surgery

Diagnosis of claw toes

For an experienced orthopedic surgeon, the claw toe misalignment is a visual diagnosis. The deformity is very characteristic. In addition to the clinical examination, the pathological callous pattern over the pressure points should be examined.

An X-ray can confirm the diagnosis and reveal the position of the joint surfaces in relation to one another. In this way, a possibly existing toe dislocation (slipping out of the joint) or joint changes caused by wear can be detected.

What is the difference to a hammer toe?

The terms hammer toes and claw toes are often used synonymously, but there are differences that define the extent of the toe deformity. With the exception of the big toe, all toes consist of three bony members that are connected to one another and to the metatarsal bones by joints. A claw toe is present when the metatarsophalangeal joint between the metatarsus and the first phalanx is hyperextended and the metatarsal joint and the end joint are flexed. This creates the typical shape of the toes, reminiscent of animal claws. In contrast to this, the hammer toe is characterized in that the toe joint is extended and the toe joint is flexed. The deformity is reminiscent of a hammer.

Also read: Hammer toe

Figure pain ankle

Foot pain

Achilles tendonitis /
Achilles tendon rupture
Broken bones - toes,
Metatarsus, tarsus
(here outer ankle fracture)
Ligament stretch / torn ligament
at the ankle
Lower and upper heel spurs
Calcaneus spur
Hammer toe and claw toe
(Deformities of the toe bones)
Digitus malleus
Plantar warts
Verrucae plantares
Hallux valgus -
(Deviation of the big toe
in the base joint)
Hallux rigidus -
(Joint wear of the
Metatarsophalangeal joint)
Inflamed nails / nail fungus
Osteoarthritis / arthritis -
degenerative change of
Joints / inflammation of the joints