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Wednesday 10 March 2021

Claw toe : causes and treatments

Claw toe : causes and treatments


A claw toe is a deformity that causes your toe to bend or curl downwards. This type of deformed toe does not necessarily have to lead to surgery. We will see what other alternatives there are.


In contrast to hammertoes, the deformity will occur at the joints between the 1st and 2ᵉ phalanges (proximal inter phalangeal joint) and between the 2ᵉ and 3ᵉ phalanges (distal inter phalangeal joint). The hammer toe, and it deformed at the distal inter phalangeal joint, that is, between the middle phalanx (2ᵉ phalanx) and the distal phalanx (3ᵉ phalanx).


This deformity can affect any toe on your foot. It most commonly affects the second or third toe. Although a claw toe may be present at birth, it usually develops over time due to arthritis or improper footwear, such as a shoe with too high a heel. In most cases, toe deformities can be treated without surgery, including the choice of a pair of shoes for deformed feet.


What do toes claw ?

Your toe contains two joints that allow it to bend in the middle and at the base. A claw toe occurs when the middle phalangeal joint is bent.


The most common causes are:

  • Traumatic injury to the toe
  • Arthritis
  • Hollow foot
  • A valgus flat foot
  • A Greek foot with a longer second metatarsal
  • Wearing shoes that do not fit properly
  • Retraction of ligaments or tendons in the foot
  • Pressure from a bunion, a deformity of the big toe that will tend to push the second toe over it
  • A quintus varus
  • Injury to the spinal cord or peripheral nerves can cause this type of condition

Risk factors

Certain factors increase the likelihood of developing toe claws:

  • Hereditary factor
  • Chronic wearing of tight or pointed shoes
  • Wearing shoes that are too small can force your toe joints into an abnormal joint position that makes it impossible to fully stretch the toe

The symptoms of this deformity

A claw toe can cause discomfort and pain that can prevent you from walking, especially when your toe is repeatedly rubbed in your shoe.


The pressure of the toe pad on the sole of the shoe can be painful, and a horn is regularly found at the flexion of the toe phalanx joint. This is caused by a conflict between your toe and the shoe upper. This is why we advise you to wear shoes with a soft, even stretchy upper to give the toes the necessary space and provide immediate relief.


Metatarsalgia can occur in this foot condition.


With this type of toe deformity, you may tend to change the way you walk to avoid a painful position. Unfortunately, this analgesic walking, with a different support, can cause pain in other joints such as the ankle, knee or hip.


We advise you to consult your doctor or a health professional specializing in foot pathologies if you have any of these symptoms.

The consultation will allow a complete podiatric assessment to be carried out and you to be directed to the most appropriate health professional for your case. This may be a podiatrist or pedorthist for the fitting of foot orthoses, a physiotherapist for toe rehabilitation or a surgeon.


A doctor can usually diagnose toe claws during a physical examination. Imaging tests, such as X-rays, may be necessary if you have suffered a bone, muscle or ligament injury to the toe.


Treatment options : How to treat a claw toe ?

The severity of the deformity will determine the options available to relieve it. If the deformity is slight, an orthoplasty and/or an orthopedic sole with adapted shoes is often sufficient. If the deformity is major, surgical treatment may be considered. In all cases, your doctor will be the best person to choose the appropriate treatment.


For a slight deformity

You can correct a claw toe caused by inadequate footwear by wearing suitable orthopedic shoes. If a hollow foot is the cause of the condition, wearing toe pads or insoles can help modify the painful pressure.



Claw toe shoe selection



Corns and other calluses that may develop should also be treated with pedicure to avoid all sorts of complications. This requires a consultation with a pedicurist who can, if necessary, make you an orthotic. This helps to relieve rubbing pain by protecting the phalangeal joint that is in conflict with the shoe.


Gently stretching your toes can also help relieve pain and reposition the affected toe. This type of rehabilitation can be done at home or by a physiotherapist.


The main complications if you do not treat your claw toes are premature osteoarthritis of the phalangeal joints and fixation of the deformities, which would lead to surgery.


For a major deformation

If you are unable to flex your toe, surgery is the only option to restore movement. Surgery can reposition the toe, remove the deformed or injured bone and realign the tendons and joints. Surgery is often necessary when there is dislocation of the phalangeal joints or when non-reducible stiffness has set in.


The operation is normally performed on an outpatient basis, under local anesthetic, so that you can go home on the day of the operation.

If possible, the specialist will use a percutaneous surgical technique. This technique is less invasive and allows for faster healing and postoperative recovery. It also reduces the risk of infection and complications, as only small incisions are made.

In some cases, conventional surgery will be necessary. In particular, if the deformities require the practice of an osteotomy (bone shortening) associated with an arthrodesis (fixing the alignment with rods) to put the toes back in the axis.


Your surgeon will be best able to explain the surgical procedure for the treatment of your toe claws. Usually, he or she will use the operation to remove any corns or calluses that may have formed and may also restore your foot to its normal bearing.
The length of recovery time will obviously depend on the technique used and on you, but it generally varies from 3 to 8 weeks.


How to avoid claw toe ?

The best way to prevent claw toe is to wear suitable shoes.

If you wear high heels, the heel height should be 5 cm or less. Wearing high-heeled shoes increases the pressure on your toes and causes them to bend. This can also lead to corns and a hollow foot.


After treating the cause of this deformity, it usually disappears without complications. However, if you wait too long before seeking treatment, your surrounding toes may become deformed under the pressure of the deformed toe. It is best to seek treatment as soon as the diagnosis is confirmed.


Author : Philippe Vesin - Pedorthist