Claw toes

The claw toes are a deformity occurs in the second, third, fourth and fifth fingers of the foot and consisting of the curvature thereof, resulting in the extension of the metatarsophalangeal joint and the interphalangeal joints flex.

This deformity can also affect the big toe, but due to the importance that this toe has in the function of the foot, it is specifically studied.

It is necessary to differentiate claw toes from other types of deformities, which, being similar, are not exactly the same. This is the case of hammer toes or mallet toes. The difference lies in the type of deformity that each one presents and in the cause that produces it, which as it is different, the treatment will also vary to some extent.

Causes of claw toes

Like other foot deformities, claw toes have been considered to cause narrow shoes with pointed toes or compressing the toes. This consideration must be qualified, since this assessment would mean that all the people who wear that type of shoe would develop a claw toe, and this is not true.

The shoe can be considered as an aggravating factor of the deformity, accelerator of its evolution or as much initiator, but it is never purely causal. Claw toes occur primarily as a result of muscle imbalances that occur in the foot. It is logical to think that the fingers are subjected to the action of the muscles that are inserted in them, and that the strengthening or weakening of these will result in the appearance of deformities such as claw toes. Ultimately, the way each person walks and the particular structure of each foot determine a different muscular action that, when it escapes from normal patterns, causes deformities in the foot.

Biomechanical alterations in human gait cause muscular imbalances at the foot and, of course, the fingers.

In the case of claw toes, the muscles that most frequently cause this deformity are the flexor muscles of the foot. These muscles are inserted in the tips of the fingers, in the last phalanx of these and are responsible for curving the finger, placing them in a claw. In the case of claw toes, there is an advantage of the flexor muscles over the extensor muscles.

The strengthening of the extensor muscles causes hammer toes to a greater extent than claw toes.

The circumstances of weakening or muscular empowerment at the level of the toes, together with the use of the wrong shoe, will develop digital deformities such as claw toes.

There are certain types of feet that are more prone to claw toes, such as people with flat or valgus feet, people with bunions , or people who have some type of neuropathy that causes spasticity of the flexor muscles of the foot. If the person wears a shoe that places the toes crowded together, and deviates them from their original position, it will cause an alteration of the digital function, which will affect the action of the muscles on them.

This circumstance can appear as an initiating factor of the deformity, and that triggers a muscular imbalance that develops the deformity of the claw toes.

Wearing narrow shoes can not only initiate the deformity but can fix it. This means that if a person has a claw toe deformity and also wears narrow shoes, it will gradually cause the stiffness of the deformity with what will worsen the disease that will cause, more painful symptoms translated into the appearance of calluses on the back of fingers, chafing and even ulcerations at this level.

What symptoms appear?

Claw toe deformity can present in three different ways depending on whether the toe can be stretched or not:

• Flexible.
• Semi-rigid.
• Rigid.

Generally, the deformity is flexible in its earliest stages and as it evolves it becomes semi-rigid and finally rigid. In the most severe stages of the deformity, the symptoms are aggravated and much more intense.

When a claw toe appears, the following symptoms may occur:

• Pain at the level of the back of the finger.
• Redness and swelling of the back of the finger.
• Corns on the back of the finger.
• Ulcers and wounds in the areas of friction with the shoe.
• Inability to put on and walk due to rubbing of the deformity with the shoe.
• Calluses on the sole of the foot, just in the metatarsal support area, due to the displacement of the plantar fat pad located in this area.

The curving of the toe causes the structures at the plantar level to move anteriorly, thus leaving the area where the metatarsals are supported by the ground unprotected.

How is it diagnosed?

As in the case of any other foot deformity, the complement of the radiological study is always important, since it will inform us about the degree of deviation of the toe and about the loss of joint congruence of the finger.

We can say that we are faced with a claw toe whenever we have a curving of the finger that consists of an extension of the joint between the phalanx of the finger and the metatarsal and a flexion of the interphalangeal joints.

It is necessary to clarify that normally the foot without support and at rest can place the toes in a claw position, but it does not mean that there is such a deformity. This position causes the muscles to claw toes, but it is important to observe the foot in support of the weight of the body and while walking

For this reason, another complementary method of diagnosis is the analysis of the person’s gait by clinical or computer means. It involves observing at what point in the gait the deformity of the finger is caused and determining whether it is normal or not.

Normally the toes bend during the march when we have the foot in the air, in the space that goes from one support to another. This physiological stooping must be differentiated from another pathological one and an accurate diagnosis of the deformity must be made, since the treatment will largely depend on this.

There are computer systems that allow us to observe and analyze human gait and compare it with what would be the normal pattern. Its application is decisive in the study of the cause that causes the deformity of the claw toes.

Claw Toe Treatment

Treatments for claw toe deformity can be divided into two groups:

Surgical Treatments

Which will be those who will try to solve the cause that has caused the deformity If the problem that caused the deformity is an alteration in the person’s way of walking, we must treat it by using an orthopedic insole that corrects its altered gait . It must be borne in mind that if we do not treat the cause, the rest of the treatments will be less effective and for life.

It must be understood that the only treatment that can return the finger to its natural position, when it comes to deformities in adults, is surgery.

There are different techniques to correct a claw toe. The most used is arthroplasty of the interphalangeal joint of the affected finger. It consists of the elimination of a portion of the phalanx of the finger, which allows to place the finger straight.

It is a very simple surgical technique that does not require any rehabilitation process for the patient and offers great satisfaction at an aesthetic and functional level, with the elimination of symptoms and the realignment of the finger to its original state. Depending on the degree of evolution of the disease, surgical techniques are more or less aggressive.

Palliative treatments

Among the palliative treatments is the chiropodological treatment of the callus that forms on the back of the fingers and is carried out by the Podiatrist. It consists of the elimination of the callus that is formed as a result of the friction caused by the abnormal position of the toe with the footwear. We can also avoid rubbing the back of the toe with the shoe, with the use of orthoses or silicone protectors or any other material that absorbs the pressure exerted by the shoe in this area.

The use of silicone orthoses can be palliative or corrective, since at certain stages of life, such as adolescence or childhood, correction of the deformity and alignment of the finger can be achieved. In the case of flexible claw fingers, the use of silicone orthoses can help reduce the symptoms of the deformity and prevent it from evolving into stages of joint stiffness and limitation of movements at the finger level.

How can I avoid it?

There are a series of habits and customs that can help prevent the appearance of claw toe:

• Wear wide shoes with rounded and square toes that allow the toes to move freely and do not squeeze.
• Do not wear high-heeled shoes, which put pressure on the ball of the foot and crowd the toes against the toe of the shoe.
• Avoid wearing small socks and stockings that compress the fingers and do not allow their mobility. Caution must be exercised when using tights that press on the toe, because generally the tights are not adapted to the measurements of the foot and are distributed in sizes that cover feet of different lengths.

If we consider that our way of walking is abnormal, we should go to the podiatrist to assess it and if necessary, institute the appropriate treatment. Prompt treatment of gait defects will prevent the development of these toe deformities.

When should I go to the podiatrist?

I should go to the Podiatrist at least once a year to analyze the way of walking and establish a treatment if deemed appropriate, thus avoiding the development of finger deformities.

If you have noticed any alteration in the correct alignment of the fingers, you should go to the podiatrist to diagnose the problem and inform you about the treatments that can solve the deformity and prevent its evolution.

If there are alterations of the fingers in children or young people, you should go to the Podiatrist as soon as possible to treat the problem as soon as possible and correct it if it is treated well in advance.