clawing during swing phase: may indicate weak ankle dorsiflexors and over-compensation of toe extensors note whether the clawing becomes worse during gait ( stance phase vs swing phase) apply pressure underneath the metatarsal heads and note degree of correction
if the claw toe deformity disappears w/ plantar flexion then the deformity is considered flexible
assess flexibility of toes w/ ankle in plantar flexion and dorsiflexion determine whether claw toes are flexible or fixed
note presence of metatarsalgia w/ associated skin changes ( plantar keratosis) determine degree of MTP hyperextension and PIP flexion when the claw toe deformities are associated with a cavus deformity, tarsal deformity should be corrected first, since clawing of toes may correct spontaneously compartment syndrome involving deep posterior compartment advanced age (decreased muscle tone and reliance of toe gripping for balance) in contrast to hammer toes which may or may not have MPT joint hyper-extension, a claw toe is always associated w/ MTP hyperextension characteristics include: MPT joints extended, flexed at the PIP joint, and hyperextended at the distal interphalangeal joint flexed IP joints are constantly irritated by shoe, & painful metatarsal callosities develop dorsiflexion of the MP joint causes the metatarsal fat pad to be pulled distally through its attachments to the proximal phalanx hyperextension of the MT joints and flexion of the IP joints, are common features of a neuropathic clawfoot or pes cavus PIP hyperflexion is caused by excessive pull of the long flexors hyperextension deformity of the MP joint is caused by excessive relative pull of the extensor tendons claw toes result from simultaneous contraction of extensors & flexors with weak or insufficient intrinsic muscles there is an imbalance between the extrinsic extensor tendons (which indirectly extend the MP joint and the intrinsics which flex the MP joint) all of the toes are usually affected, although contracture of the great toe can be the most severe When conservative treatment does not relieve symptoms, your doctor may suggest surgical correction of the toe.- claw toe consists of hyperextension at the metatarsophalangeal joint, and flexion at the proximal (and distal interphalangeal joints) What are the Treatment Options for Claw Toe?Ĭlaw toe is first treated conservatively with regular stretching of the toe and toe joints, wearing soft comfortable shoes with a broader toe box, or splinting or taping to hold or align the toes in the correct position. When you present to your doctor’s office with these symptoms, your doctor performs a physical examination of the foot and orders tests to rule out other nerve disorders that can weaken the muscles in the foot. Women are affected more often than men since claw toe can also form by wearing very tight or high-heeled shoes. It may be present at birth or acquired later due to other disorders such as rheumatoid arthritis, cerebral palsy and brain injury. What are the Common Causes of Claw Toe?Ĭlaw toe can occur in the four toes other than the big toe due to nerve damage, which weakens the muscles. Hard, thick skin called corns may develop under the ball of the foot or on the top of the affected toe, causing pain while walking. The affected toe is bent upward from the joint at the ball of the foot, and downward at the joints in the middle and tip of the toe to curl under the foot. Claw toe is a deformity where a toe bends and appears like a bird’s claw.